Healthcare Provider Details

I. General information

NPI: 1699399816
Provider Name (Legal Business Name): FELIZARDO S. CAMILON, JR., M.D., F.A.A.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 275
ORANGE CA
92868-4547
US

IV. Provider business mailing address

505 S MAIN ST STE 275
ORANGE CA
92868-4547
US

V. Phone/Fax

Practice location:
  • Phone: 714-836-6607
  • Fax: 714-836-6600
Mailing address:
  • Phone: 714-836-6607
  • Fax: 714-836-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: FELIZARDO S. CAMILON JR.
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 714-836-6607