=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588894844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON NICHOLAS CAMU PSY.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2009
-----------------------------------------------------
Last Update Date | 07/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7720 EL CAMINO REAL SUITE 2B-1
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-8508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-828-3835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7720 EL CAMINO REAL SUITE 2B-1
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-8508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-828-3835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY 17682
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------