1023438561 NPI number — CAMILLA MCCALMONT, MD INC

Table of content: (NPI 1023438561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023438561 NPI number — CAMILLA MCCALMONT, MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMILLA MCCALMONT, MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023438561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 HILLSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIEDMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94611-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-918-0224
Provider Business Mailing Address Fax Number:
510-527-4123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6431 FAIRMOUNT AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
EL CERRITO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94530-3655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-527-8865
Provider Business Practice Location Address Fax Number:
510-527-4123
Provider Enumeration Date:
04/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCCALMONT
Authorized Official First Name:
CAMILLA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
510-527-8865

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A482930 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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