Healthcare Provider Details

I. General information

NPI: 1295944809
Provider Name (Legal Business Name): MS. ALESSANDRA KAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 LINCOLN AVE
SAN RAFAEL CA
94901-2021
US

IV. Provider business mailing address

359 MONTFORD AVE
MILL VALLEY CA
94941-3314
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-4755
  • Fax:
Mailing address:
  • Phone: 415-457-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRW0400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: