Provider Demographics
NPI:1760923262
Name:CAMARENA, ROGELIO JR
Entity Type:Individual
Prefix:MR
First Name:ROGELIO
Middle Name:
Last Name:CAMARENA
Suffix:JR
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 1:513 CHATSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4005
Mailing Address - Country:US
Mailing Address - Phone:818-389-3371
Mailing Address - Fax:
Practice Address - Street 1:513 CHATSWORTH DR
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4005
Practice Address - Country:US
Practice Address - Phone:818-389-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner