Provider Demographics
NPI:1134333842
Name:CAMERON, ATOUSSA (FNP)
Entity type:Individual
Prefix:
First Name:ATOUSSA
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ATOUSSA
Other - Middle Name:AHMADI
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25065 EATON LANE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-495-1875
Mailing Address - Fax:
Practice Address - Street 1:30280 RANCHO VIEJO ROAD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-248-1632
Practice Address - Fax:949-248-9339
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner