Healthcare Provider Details

I. General information

NPI: 1700516036
Provider Name (Legal Business Name): CAMILLE LEBLANC CPC, CCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062-2799
US

IV. Provider business mailing address

825 MARSHALL ST APT 232
REDWOOD CITY CA
94063-2166
US

V. Phone/Fax

Practice location:
  • Phone: 650-321-9999
  • Fax: 650-571-9990
Mailing address:
  • Phone: 650-868-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number219084-0157
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: