Provider Demographics
NPI:1417126772
Name:RODRIGUEZ, CAMILLE AMBER (MA00024854)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:AMBER
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA00024854
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S PINE ST
Mailing Address - Street 2:SUITE201
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2793
Mailing Address - Country:US
Mailing Address - Phone:253-396-1000
Mailing Address - Fax:253-396-1012
Practice Address - Street 1:601 S PINE ST
Practice Address - Street 2:SUITE201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2793
Practice Address - Country:US
Practice Address - Phone:253-396-1000
Practice Address - Fax:253-396-1012
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024854225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist