Provider Demographics
NPI:1689885279
Name:CAMOUSE, MELISSA (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:CAMOUSE
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:PO BOX 3704
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7243
Mailing Address - Country:US
Mailing Address - Phone:424-206-1406
Mailing Address - Fax:
Practice Address - Street 1:23456 HAWTHORNE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-540-5272
Practice Address - Fax:310-540-5271
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 9923207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACU464YMedicare UPIN