Provider Demographics
NPI:1073187936
Name:FISHER, CAMERON (PA)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 W COLORADO ST STE 205
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3640
Mailing Address - Country:US
Mailing Address - Phone:323-794-1403
Mailing Address - Fax:323-488-9782
Practice Address - Street 1:50 ALESSANDRO PL STE 310
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4000
Practice Address - Country:US
Practice Address - Phone:626-288-0008
Practice Address - Fax:866-741-4630
Is Sole Proprietor?:No
Enumeration Date:2021-05-16
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant