Provider Demographics
NPI:1578887337
Name:CHANDLER, CAMILLE YVETTE (DO)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:YVETTE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PEACH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2871
Mailing Address - Country:US
Mailing Address - Phone:805-543-4043
Mailing Address - Fax:805-543-7640
Practice Address - Street 1:1250 PEACH ST STE A
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2871
Practice Address - Country:US
Practice Address - Phone:805-543-4043
Practice Address - Fax:805-543-7640
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO162164207Q00000X
WAOP60370105207Q00000X
390200000X
CA20A12124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program