Provider Demographics
NPI:1982715512
Name:CAMILON, FELIZARDO S JR (MD)
Entity Type:Individual
Prefix:
First Name:FELIZARDO
Middle Name:S
Last Name:CAMILON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 S MAIN ST
Mailing Address - Street 2:STE 275
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4509
Mailing Address - Country:US
Mailing Address - Phone:714-836-6607
Mailing Address - Fax:714-836-6600
Practice Address - Street 1:505 S MAIN ST
Practice Address - Street 2:STE 275
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4509
Practice Address - Country:US
Practice Address - Phone:714-836-6607
Practice Address - Fax:714-836-6600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45952207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G459520Medicaid