Provider Demographics
NPI:1396438347
Name:BIRD, CAMERON SCOTT
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:SCOTT
Last Name:BIRD
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 1:36330 HIDDEN SPRINGS RD STE E6
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-5803
Mailing Address - Country:US
Mailing Address - Phone:951-370-0625
Mailing Address - Fax:
Practice Address - Street 1:36330 HIDDEN SPRINGS RD STE E6
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-5803
Practice Address - Country:US
Practice Address - Phone:951-370-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst