Provider Demographics
NPI:1326605502
Name:CAMARENA, DIEGO
Entity Type:Individual
Prefix:
First Name:DIEGO
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 1:1065 C ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-4427
Mailing Address - Country:US
Mailing Address - Phone:831-224-4023
Mailing Address - Fax:
Practice Address - Street 1:9360 N NAME UNO STE 130
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3535
Practice Address - Country:US
Practice Address - Phone:408-843-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician