Provider Demographics
NPI:1073800991
Name:TOLOUI, CAMMIE (LMT)
Entity Type:Individual
Prefix:
First Name:CAMMIE
Middle Name:
Last Name:TOLOUI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:TOLOUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2920 SE WAVERLEIGH BLVD
Mailing Address - Street 2:#10
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2061
Mailing Address - Country:US
Mailing Address - Phone:503-477-0036
Mailing Address - Fax:
Practice Address - Street 1:833 SE MAIN ST
Practice Address - Street 2:#422
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3454
Practice Address - Country:US
Practice Address - Phone:503-477-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist