Provider Demographics
NPI:1417541087
Name:CAMERON, AMY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23141 MOULTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1241
Mailing Address - Country:US
Mailing Address - Phone:949-258-3741
Mailing Address - Fax:
Practice Address - Street 1:11800 CENTRAL AVE STE 125
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7202
Practice Address - Country:US
Practice Address - Phone:909-517-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016156363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health