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General NPI Number Information
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NPI Number | 1457937898
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Entity Type | Individual
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Provider Name | MARIAM BONYADI CAMACHO MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 8950 VILLA LA JOLLA DR STE C129
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City | LA JOLLA
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State | CA
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Zip | 92037-1707
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Country | US
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Telephone | 858-450-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 8950 VILLA LA JOLLA DR STE C129
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City | LA JOLLA
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State | CA
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Zip | 92037-1707
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Country | US
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Telephone | 858-450-5900
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A185860
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License Number State | CA
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