Provider Demographics
NPI:1326452665
Name:CAMILLE PARKER
Entity Type:Organization
Organization Name:CAMILLE PARKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-715-0759
Mailing Address - Street 1:364 KRALIK ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-8006
Mailing Address - Country:US
Mailing Address - Phone:619-715-0759
Mailing Address - Fax:
Practice Address - Street 1:364 KRALIK ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-8006
Practice Address - Country:US
Practice Address - Phone:619-715-0759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-15
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB4442729313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility