Healthcare Provider Details

I. General information

NPI: 1225032667
Provider Name (Legal Business Name): CAMILLA S MCCALMONT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FAIRMOUNT AVE STE 3
EL CERRITO CA
94530-3624
US

IV. Provider business mailing address

145 HILLSIDE AVE
PIEDMONT CA
94611-3904
US

V. Phone/Fax

Practice location:
  • Phone: 510-527-8865
  • Fax: 510-527-4123
Mailing address:
  • Phone: 510-527-8865
  • Fax: 510-527-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA48293
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA48293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: