MEDICARE: ARIEL CAMP

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1316384282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL CAMP

Provider Business Mailing Address
First Line	:	931 S ATLANTIC BLVD
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-2259
Country	:	US
Telephone Number	:	626-616-9719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 W. GARVEY AVE. NORTH
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790
Country	:	US
Telephone Number	:	626-962-6061
Fax Number	:

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

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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