Provider Demographics
NPI:1255994547
Name:CAMARENA, HEATHER ANNE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:CAMARENA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4459 CORTE ARBUSTO
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4048
Mailing Address - Country:US
Mailing Address - Phone:805-403-8296
Mailing Address - Fax:
Practice Address - Street 1:2240 E GONZALES RD STE 170
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8215
Practice Address - Country:US
Practice Address - Phone:805-981-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA683663163WL0100X
CAL-49908174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant