Provider Demographics
NPI:1790817617
Name:KOCHENDERFER, CAMILLA R (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLA
Middle Name:R
Last Name:KOCHENDERFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13546 JADESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2815
Mailing Address - Country:US
Mailing Address - Phone:858-755-4387
Mailing Address - Fax:858-755-4987
Practice Address - Street 1:13546 JADESTONE WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2815
Practice Address - Country:US
Practice Address - Phone:858-755-4387
Practice Address - Fax:858-755-4987
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57985207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB58031Medicare UPIN