Provider Demographics
NPI:1992786792
Name:CAMARENA, RAFAEL (NP)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:CAMARENA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 MERCED ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1811
Mailing Address - Country:US
Mailing Address - Phone:559-445-0391
Mailing Address - Fax:559-432-4306
Practice Address - Street 1:2505 MERCED ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1811
Practice Address - Country:US
Practice Address - Phone:559-445-0391
Practice Address - Fax:559-432-4306
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411168363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health