Healthcare Provider Details

I. General information

NPI: 1306266655
Provider Name (Legal Business Name): LUKE JAMES CAMARILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SNEATH LN STE 307
SAN BRUNO CA
94066-2349
US

IV. Provider business mailing address

1001 SNEATH LN STE 307
SAN BRUNO CA
94066-2349
US

V. Phone/Fax

Practice location:
  • Phone: 650-922-4578
  • Fax: 650-244-1447
Mailing address:
  • Phone: 650-922-4578
  • Fax: 650-244-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number823814
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number823814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: