Healthcare Provider Details

I. General information

NPI: 1124596010
Provider Name (Legal Business Name): CAM MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY # 401
LAGUNA BEACH CA
92651-3681
US

IV. Provider business mailing address

830 EMERALD BAY
LAGUNA BEACH CA
92651-1227
US

V. Phone/Fax

Practice location:
  • Phone: 801-508-4155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CAMBRIA JUDD
Title or Position: PHYSICIAN, OWNER
Credential: MD
Phone: 801-508-4155