Provider Demographics
NPI:1578110508
Name:STEWART, CAMERON (BOCO, BOCP)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:BOCO, BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 CHICAGO AVE STE L21
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2326
Mailing Address - Country:US
Mailing Address - Phone:909-573-5690
Mailing Address - Fax:877-310-1729
Practice Address - Street 1:1760 CHICAGO AVE STE L21
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2326
Practice Address - Country:US
Practice Address - Phone:517-827-0009
Practice Address - Fax:877-310-1729
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter