Provider Demographics
NPI:1649024357
Name:CAMARILLO, VANESSA ROSE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ROSE
Last Name:CAMARILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W130S9599 JIMMY DEMARET DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-5241
Mailing Address - Country:US
Mailing Address - Phone:414-405-9147
Mailing Address - Fax:
Practice Address - Street 1:W130S9599 JIMMY DEMARET DR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-5241
Practice Address - Country:US
Practice Address - Phone:414-405-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program