Provider Demographics
NPI:1154333052
Name:CAMARA, CHRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CAMARA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:
Practice Address - Street 1:2921 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-5314
Practice Address - Country:US
Practice Address - Phone:805-487-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM18553HMedicaid
CA95-1683892OtherOTHER INSURANCE
CARHM08608FMedicaid
CARHM08609FMedicaid
CAZZT40394FMedicaid
CAWPA17471CMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid
CA95-1683892OtherOTHER INSURANCE
CAWPA17471FMedicare ID - Type UnspecifiedPPIN
CAWPA17471EMedicare ID - Type UnspecifiedPPIN
CAZZT40394FMedicaid
CARHM08608FMedicaid