Provider Demographics
NPI:1891190443
Name:CAMACARO, YESENIA E (DDS)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:E
Last Name:CAMACARO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 E REGENT ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1415
Mailing Address - Country:US
Mailing Address - Phone:714-470-2023
Mailing Address - Fax:
Practice Address - Street 1:652 E REGENT ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1415
Practice Address - Country:US
Practice Address - Phone:714-470-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice