Provider Demographics
NPI:1184373102
Name:CAMARENA, ISELA (HHP, CMT)
Entity type:Individual
Prefix:
First Name:ISELA
Middle Name:
Last Name:CAMARENA
Suffix:
Gender:F
Credentials:HHP, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N EL CAMINO REAL STE 306
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2814
Mailing Address - Country:US
Mailing Address - Phone:858-673-4400
Mailing Address - Fax:858-673-4499
Practice Address - Street 1:15611 POMERADO RD STE 520
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2437
Practice Address - Country:US
Practice Address - Phone:858-673-4400
Practice Address - Fax:858-673-4499
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69825225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA264676582OtherTAX ID