Provider Demographics
NPI:1801137773
Name:MUSSO, CAMILLE VICTORIA (LAC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:VICTORIA
Last Name:MUSSO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 BLUEBONNET LN
Mailing Address - Street 2:UNIT 8
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4810
Mailing Address - Country:US
Mailing Address - Phone:337-274-4488
Mailing Address - Fax:
Practice Address - Street 1:2414 EXPOSITION BLVD
Practice Address - Street 2:BLDG BC SUITE 203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-2200
Practice Address - Country:US
Practice Address - Phone:337-274-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist