Provider Demographics
NPI:1083291710
Name:MOTZ, CAMERON ALEXANDER (ATC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:ALEXANDER
Last Name:MOTZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12368 CLAREDON DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8069
Mailing Address - Country:US
Mailing Address - Phone:909-527-5982
Mailing Address - Fax:
Practice Address - Street 1:16455 WEDGEWORTH DR
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-3045
Practice Address - Country:US
Practice Address - Phone:626-934-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty