Provider Demographics
NPI:1194406041
Name:CAMARILLO, ARSENIO CABAMONGAN III
Entity type:Individual
Prefix:MR
First Name:ARSENIO
Middle Name:CABAMONGAN
Last Name:CAMARILLO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 POTRERO CIR
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-4136
Mailing Address - Country:US
Mailing Address - Phone:916-755-8538
Mailing Address - Fax:
Practice Address - Street 1:1373 POTRERO CIR
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-4136
Practice Address - Country:US
Practice Address - Phone:916-755-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920719330343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)