Provider Demographics
NPI:1922442466
Name:ESCOVEDO, CAMERON JAMES (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:JAMES
Last Name:ESCOVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-4467
Mailing Address - Fax:310-423-4131
Practice Address - Street 1:8700 BEVERLY BLVD STE 4221
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-4467
Practice Address - Fax:310-423-4131
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics