Provider Demographics
NPI:1467719765
Name:CAMARENA, MIRNA ESTELA (BS)
Entity Type:Individual
Prefix:MS
First Name:MIRNA
Middle Name:ESTELA
Last Name:CAMARENA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14660 OXNARD STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:91411
Mailing Address - Country:US
Mailing Address - Phone:818-901-4836
Mailing Address - Fax:
Practice Address - Street 1:14660 OXNARD STREET
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411
Practice Address - Country:US
Practice Address - Phone:818-901-4836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner