Healthcare Provider Details

I. General information

NPI: 1790156271
Provider Name (Legal Business Name): CAMDEN PHYSICIANS GROU, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 SANTA MONICA BLVD SUITE 105
LOS ANGELES CA
90025-4749
US

IV. Provider business mailing address

10780 SANTA MONICA BLVD SUITE 105
LOS ANGELES CA
90025-4749
US

V. Phone/Fax

Practice location:
  • Phone: 844-422-6336
  • Fax:
Mailing address:
  • Phone: 844-422-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25565
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY19135
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS59977
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC48114
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberAC11797
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11797
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA112538
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA100456
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D2068012
License Number StateCA
# 10
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS JESSICA KLEIN
Title or Position: SECRETARY
Credential:
Phone: 844-422-6336