MEDICARE: CHARLES A CAMARATA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	C20474	CA

General Provider Information

NPI Number	:	1316106396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A CAMARATA MD

Provider Business Mailing Address
First Line	:	3450 BONITA RD STE 105
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-3249
Country	:	US
Telephone Number	:	619-691-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 BONITA RD STE 105
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-3249
Country	:	US
Telephone Number	:	619-691-1399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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