Healthcare Provider Details

I. General information

NPI: 1801686746
Provider Name (Legal Business Name): CAMILLE SIMONE MOLTZEN BA/MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 HENDERSON ST
ALTURAS CA
96101-3921
US

IV. Provider business mailing address

139 HENDERSON ST
ALTURAS CA
96101-3921
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-7101
  • Fax:
Mailing address:
  • Phone: 530-233-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number2475B24E6D
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: