Healthcare Provider Details

I. General information

NPI: 1851357917
Provider Name (Legal Business Name): CAMERON ISAO OBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SAMARITAN DR SUITE 201
SAN JOSE CA
95124-3909
US

IV. Provider business mailing address

2410 SAMARITAN DR SUITE 201
SAN JOSE CA
95124-3909
US

V. Phone/Fax

Practice location:
  • Phone: 408-371-9010
  • Fax: 408-371-2633
Mailing address:
  • Phone: 408-371-9010
  • Fax: 408-371-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA68975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: