Healthcare Provider Details

I. General information

NPI: 1063238624
Provider Name (Legal Business Name): CAMILLE MARIE KNOTH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMILLE MARIE JARROLD PA

II. Dates (important events)

Enumeration Date: 11/28/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 VISTA WAY STE 200
OCEANSIDE CA
92056-4519
US

IV. Provider business mailing address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-6767
  • Fax:
Mailing address:
  • Phone: 760-736-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: