Healthcare Provider Details

I. General information

NPI: 1619358157
Provider Name (Legal Business Name): CAMILA BAHAMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3772 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

IV. Provider business mailing address

PO BOX 55065
RIVERSIDE CA
92517-0065
US

V. Phone/Fax

Practice location:
  • Phone: 951-222-3111
  • Fax: 951-682-7904
Mailing address:
  • Phone: 951-222-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA162479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: