Provider Demographics
NPI:1619486487
Name:CAMEROS, KEVIN MOLINA
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MOLINA
Last Name:CAMEROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 WHITE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6010
Mailing Address - Country:US
Mailing Address - Phone:800-977-2273
Mailing Address - Fax:
Practice Address - Street 1:11000 WHITE ROCK RD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6010
Practice Address - Country:US
Practice Address - Phone:800-977-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist