Provider Demographics
NPI:1770710030
Name:POOLE, KAMERON ALEXANDRA (MD)
Entity type:Individual
Prefix:
First Name:KAMERON
Middle Name:ALEXANDRA
Last Name:POOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMERON
Other - Middle Name:ALEXANDRA
Other - Last Name:TEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5601 DE SOTO AVE
Mailing Address - Street 2:LL B480
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6701
Mailing Address - Country:US
Mailing Address - Phone:818-719-3440
Mailing Address - Fax:818-719-3816
Practice Address - Street 1:5601 DE SOTO AVE
Practice Address - Street 2:LL B480
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6701
Practice Address - Country:US
Practice Address - Phone:818-719-3440
Practice Address - Fax:818-719-3816
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116648207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology