Healthcare Provider Details

I. General information

NPI: 1235799867
Provider Name (Legal Business Name): MARC CAMILON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ STE 3325
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLZ STE 3325
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 714-745-8258
  • Fax:
Mailing address:
  • Phone: 714-745-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA195226
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL82838
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: