Provider Demographics
NPI:1477734663
Name:CAMARENA, HERIBERTO
Entity type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:CAMARENA
Suffix:
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 1:139 CAFARO CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1038
Mailing Address - Country:US
Mailing Address - Phone:530-758-4078
Mailing Address - Fax:916-287-4679
Practice Address - Street 1:212 I ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4213
Practice Address - Country:US
Practice Address - Phone:530-758-4078
Practice Address - Fax:916-287-4679
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator