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General NPI Number Information
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NPI Number | 1164424594
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Entity Type | Individual
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Provider Name | MARCI CAMENISCH PAC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 1479 W LACEY BLVD
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City | HANFORD
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State | CA
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Zip | 93230-5906
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Country | US
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Telephone | 559-583-4617
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Fax | 559-583-4625
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Provider Business Mailing Address
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Address Line | 501 6TH ST
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City | TAFT
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State | CA
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Zip | 93268-2704
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Country | US
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Telephone | 661-763-5131
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Fax | 667-763-5137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13244
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License Number State | CA
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