Provider Demographics
NPI:1871709493
Name:CAMARGO, MAYRA ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:ELIZABETH
Last Name:CAMARGO
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 1:9240 DATE ST
Mailing Address - Street 2:APT. 12-C
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8724
Mailing Address - Country:US
Mailing Address - Phone:714-357-1981
Mailing Address - Fax:
Practice Address - Street 1:560 S SAN JOSE AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3144
Practice Address - Country:US
Practice Address - Phone:626-967-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATFC6365Medicaid