Healthcare Provider Details

I. General information

NPI: 1326957721
Provider Name (Legal Business Name): SADIE CAMILLIERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 MORENA BLVD STE 103
SAN DIEGO CA
92117-4547
US

IV. Provider business mailing address

4312 ECHO CT APT A
LA MESA CA
91941-6656
US

V. Phone/Fax

Practice location:
  • Phone: 619-356-1315
  • Fax:
Mailing address:
  • Phone: 443-975-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: