Basic Information
| Provider Information | |||||||||
| NPI: | 1922113885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMAREN | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 255228 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958655228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004700071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 29TH ST | ||||||||
| Address2: | SUITE 570A | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333792 | ||||||||
| FaxNumber: | 9167333805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA16478 | CA | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207NS0135X | PA16478 | CA | X | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207NP0225X | PA16478 | CA | X | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 0PA164780 | 05 | CA | MEDICAID |