Provider Demographics
NPI:1629297080
Name:VERDUGO, CAMILLE
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:
Last Name:VERDUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 E OLIVINE RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85243-4901
Mailing Address - Country:US
Mailing Address - Phone:480-330-8314
Mailing Address - Fax:
Practice Address - Street 1:2700 N 3RD ST
Practice Address - Street 2:STE. 4000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1129
Practice Address - Country:US
Practice Address - Phone:602-200-9494
Practice Address - Fax:602-957-4785
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator