Provider Demographics
NPI:1720595374
Name:TAIWO, CAMILLE (BS, MAT, MAEL)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:
Last Name:TAIWO
Suffix:
Gender:F
Credentials:BS, MAT, MAEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E SAHARA AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3707
Mailing Address - Country:US
Mailing Address - Phone:888-601-6336
Mailing Address - Fax:702-834-6890
Practice Address - Street 1:1810 E SAHARA AVE STE 212
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3707
Practice Address - Country:US
Practice Address - Phone:702-772-9604
Practice Address - Fax:702-834-6890
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker