Provider Demographics
NPI:1811734916
Name:SCANLAN, CAMERON ALAN
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ALAN
Last Name:SCANLAN
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 1:263 LLANO DE LOS ROBLES AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-5084
Mailing Address - Country:US
Mailing Address - Phone:559-412-3885
Mailing Address - Fax:
Practice Address - Street 1:263 LLANO DE LOS ROBLES AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-5084
Practice Address - Country:US
Practice Address - Phone:559-412-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA743290164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse