Provider Demographics
NPI:1801686746
Name:MOLTZEN, CAMILLE SIMONE (BA/MS)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:SIMONE
Last Name:MOLTZEN
Suffix:
Gender:F
Credentials:BA/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-3921
Mailing Address - Country:US
Mailing Address - Phone:530-233-7101
Mailing Address - Fax:
Practice Address - Street 1:139 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3921
Practice Address - Country:US
Practice Address - Phone:530-233-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2475B24E6D171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach