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General NPI Number Information
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NPI Number | 1740511369
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Entity Type | Organization
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Legal Business Name | CAMILO S JORGE M.D. PROF CORP
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 16415 COLORADO AVE SUITE 102
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City | PARAMOUNT
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State | CA
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Zip | 90723-5035
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Country | US
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Telephone | 562-531-1946
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Fax | 562-531-1010
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Provider Business Mailing Address
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Address Line | 16415 COLORADO AVE SUITE 102
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City | PARAMOUNT
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State | CA
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Zip | 90723-5035
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Country | US
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Telephone | 562-531-1946
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Fax | 562-531-1010
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BERNARD S JORGE
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Credential | M.D.
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Telephone | 562-531-1946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A18393
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License Number State | CA
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