Provider Demographics
NPI:1407212947
Name:CAMARENA, MARIA LOURDES (MFTI)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LOURDES
Last Name:CAMARENA
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16630 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-2045
Mailing Address - Country:US
Mailing Address - Phone:909-697-8269
Mailing Address - Fax:
Practice Address - Street 1:16823 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3803
Practice Address - Country:US
Practice Address - Phone:909-355-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 86152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist