Healthcare Provider Details

I. General information

NPI: 1073707758
Provider Name (Legal Business Name): CAMELA OGRON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24552 PASEO DE VALENCIA
LAGUNA HILLS CA
92653-4236
US

IV. Provider business mailing address

330 CLIFF DR
LAGUNA BEACH CA
92651-1671
US

V. Phone/Fax

Practice location:
  • Phone: 949-609-7844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: