Provider Demographics
NPI:1699005421
Name:CAMERON, CHRISTIONA STAR
Entity Type:Individual
Prefix:
First Name:CHRISTIONA
Middle Name:STAR
Last Name:CAMERON
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 1:3130 OAK RD
Mailing Address - Street 2:APT # 219
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7713
Mailing Address - Country:US
Mailing Address - Phone:925-219-7730
Mailing Address - Fax:
Practice Address - Street 1:3130 OAK RD
Practice Address - Street 2:#219
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597
Practice Address - Country:US
Practice Address - Phone:925-219-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT34609171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor