Provider Demographics
NPI:1558670786
Name:CAMARENA, IRENE FONSECA (BA)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:FONSECA
Last Name:CAMARENA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44000 OLD WARM SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6145
Mailing Address - Country:US
Mailing Address - Phone:408-493-3897
Mailing Address - Fax:
Practice Address - Street 1:1510 PARKMOOR AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2418
Practice Address - Country:US
Practice Address - Phone:408-605-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator