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General NPI Number Information
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NPI Number | 1326452665
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Entity Type | Organization
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Legal Business Name | CAMILLE PARKER
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Dates
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Enumeration Date | 06/15/2014
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Last Update Date | 06/15/2014
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Provider Practice Location Address
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Address Line | 364 KRALIK ST
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City | OCEANSIDE
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State | CA
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Zip | 92058-8006
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Country | US
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Telephone | 619-715-0759
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Fax |
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Provider Business Mailing Address
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Address Line | 364 KRALIK ST
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City | OCEANSIDE
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State | CA
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Zip | 92058-8006
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Country | US
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Telephone | 619-715-0759
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Fax |
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Authorized Official
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Title or Position | LVN
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Name | MRS. CAMILLE MONIQUE PARKER
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Credential |
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Telephone | 619-715-0759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | B4442729
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License Number State | CA
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