Healthcare Provider Details

I. General information

NPI: 1295144210
Provider Name (Legal Business Name): MARVIN CAMARA SANCHEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 TARAWA RD
SAN DIEGO CA
92155-5003
US

IV. Provider business mailing address

34800 BOB WILSON DR STE 14
SAN DIEGO CA
92134-1014
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-5539
  • Fax:
Mailing address:
  • Phone: 619-532-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: