Provider Demographics
NPI:1942044482
Name:CAMARILLO, JENNIFER (BSN, RN, PHN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CAMARILLO
Suffix:
Gender:U
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W 17TH ST # 101E
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2316
Mailing Address - Country:US
Mailing Address - Phone:714-834-6663
Mailing Address - Fax:
Practice Address - Street 1:1725 W 17TH ST # 101E
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-834-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95264481163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse