Healthcare Provider Details

I. General information

NPI: 1396616868
Provider Name (Legal Business Name): CANDICE CAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PACKET LANDING RD
ALAMEDA CA
94502-6534
US

IV. Provider business mailing address

1305 WEBSTER ST APT C305
ALAMEDA CA
94501-3863
US

V. Phone/Fax

Practice location:
  • Phone: 510-748-4003
  • Fax:
Mailing address:
  • Phone: 510-703-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number7422362635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: