Provider Demographics
NPI:1164620431
Name:VARDY, CAMILLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:
Last Name:VARDY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SAN ANTONIO CIR
Mailing Address - Street 2:SUITE 154
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1254
Mailing Address - Country:US
Mailing Address - Phone:650-949-2777
Mailing Address - Fax:650-949-2778
Practice Address - Street 1:201 SAN ANTONIO CIR
Practice Address - Street 2:SUITE 154
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1254
Practice Address - Country:US
Practice Address - Phone:650-949-2777
Practice Address - Fax:650-949-2778
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4860171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist