MEDICARE: AMY CAMERON PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95016156	CA

General Provider Information

NPI Number	:	1417541087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CAMERON PMHNP-BC

Provider Business Mailing Address
First Line	:	23141 MOULTON PKWY
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1241
Country	:	US
Telephone Number	:	949-258-3741
Fax Number	:

Provider Business Practice Location Address
First Line	:	11800 CENTRAL AVE STE 125
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-7202
Country	:	US
Telephone Number	:	909-517-2020
Fax Number	:

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

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	03/18/2024

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