Healthcare Provider Details

I. General information

NPI: 1023196599
Provider Name (Legal Business Name): CAMILLE MARIE ZIOMEK M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W A ST
DIXON CA
95620-3437
US

IV. Provider business mailing address

PO BOX 779
STOCKTON CA
95201-0779
US

V. Phone/Fax

Practice location:
  • Phone: 707-635-1600
  • Fax: 707-635-1641
Mailing address:
  • Phone: 209-373-2800
  • Fax: 209-373-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: