Healthcare Provider Details

I. General information

NPI: 1083661896
Provider Name (Legal Business Name): VINCENT CAMARDA PH D MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W CREST ST SUITE 102
ESCONDIDO CA
92025-1739
US

IV. Provider business mailing address

PO BOX 609001
SAN DIEGO CA
92160-9001
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-4930
  • Fax: 760-489-4933
Mailing address:
  • Phone: 619-528-4600
  • Fax: 619-528-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFG17247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: