Healthcare Provider Details

I. General information

NPI: 1407529936
Provider Name (Legal Business Name): CAMILLE JENSEN TIBERGHIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 02/24/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 ACUNA CT
CARLSBAD CA
92009-6401
US

IV. Provider business mailing address

2156 VIA CAMINO VERDE APT 2
OCEANSIDE CA
92054-7363
US

V. Phone/Fax

Practice location:
  • Phone: 916-744-2299
  • Fax:
Mailing address:
  • Phone: 714-586-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: