MEDICARE: LOUIS CAMARILLO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	32760	CA

General Provider Information

NPI Number	:	1326478546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS CAMARILLO D.C.

Provider Business Mailing Address
First Line	:	5300 FAIRVIEW BLVD
Second Line	:	APT 15
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-2382
Country	:	US
Telephone Number	:	503-508-8570
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2243
Country	:	US
Telephone Number	:	503-508-8570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2013
Last Update Date	:	04/27/2017

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