Healthcare Provider Details

I. General information

NPI: 1295804029
Provider Name (Legal Business Name): CAMILO Q. PRIMERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W ROUTE 66
GLENDORA CA
91740-6207
US

IV. Provider business mailing address

500 S MAIN ST 1210
ORANGE CA
92868-4507
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-0231
  • Fax: 626-335-5082
Mailing address:
  • Phone: 714-560-1580
  • Fax: 714-560-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA31170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: