Provider Demographics
NPI:1649951864
Name:CAMARENA, ISAAC ABRAHAM
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:ABRAHAM
Last Name:CAMARENA
Suffix:
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 1:4211 S AVALON BLVD AIP
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011
Mailing Address - Country:US
Mailing Address - Phone:323-474-0438
Mailing Address - Fax:
Practice Address - Street 1:4211 S AVALON BLVD
Practice Address - Street 2:AIP
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:323-474-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program