Provider Demographics
NPI:1083322168
Name:MUNDH, CAMILLE L (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:L
Last Name:MUNDH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-9435
Mailing Address - Country:US
Mailing Address - Phone:530-617-2071
Mailing Address - Fax:
Practice Address - Street 1:9792 LIVE OAK BLVD STE E
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2381
Practice Address - Country:US
Practice Address - Phone:530-701-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine