Provider Demographics
NPI:1851873343
Name:CAMERON, EDWARD
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:CAMERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8898 CLAIREMONT MESA BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1127
Mailing Address - Country:US
Mailing Address - Phone:858-715-1211
Mailing Address - Fax:858-715-1274
Practice Address - Street 1:8898 CLAIREMONT MESA BLVD , SAN DIEGO, CA 92
Practice Address - Street 2:SUITE H
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-715-1211
Practice Address - Fax:858-715-1274
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29110167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician