Provider Demographics
NPI:1326155268
Name:CAMOUS, MARIANNE E (PA)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:E
Last Name:CAMOUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:129 DOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-1629
Mailing Address - Country:US
Mailing Address - Phone:650-704-0601
Mailing Address - Fax:
Practice Address - Street 1:1663 ROLLINS RD
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2301
Practice Address - Country:US
Practice Address - Phone:650-692-2663
Practice Address - Fax:650-692-2777
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS82031Medicare UPIN