Healthcare Provider Details

I. General information

NPI: 1891145074
Provider Name (Legal Business Name): CAMILLA R. SULAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E ROMIE LN
SALINAS CA
93901-4029
US

IV. Provider business mailing address

450 E ROMIE LN
SALINAS CA
93901-4029
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-7389
  • Fax:
Mailing address:
  • Phone: 831-424-7389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39254
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA162158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: