Healthcare Provider Details

I. General information

NPI: 1215501382
Provider Name (Legal Business Name): CAMILLE LAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 MIRATECH DR
SAN DIEGO CA
92121-3109
US

IV. Provider business mailing address

1607 GLENWOOD DR
SAN DIEGO CA
92103-4734
US

V. Phone/Fax

Practice location:
  • Phone: 858-304-6440
  • Fax: 858-952-0502
Mailing address:
  • Phone: 619-302-5074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number28367
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number28367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: