MEDICARE: CAMERON STEWART BOCO, BOCP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	222Z00000X	Orthotist
2	1744P3200X	Prosthetics Case Management
3	225000000X	Orthotic Fitter
4	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1578110508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON STEWART BOCO, BOCP

Provider Business Mailing Address
First Line	:	1760 CHICAGO AVE STE L21
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2326
Country	:	US
Telephone Number	:	909-573-5690
Fax Number	:	877-310-1729

Provider Business Practice Location Address
First Line	:	1760 CHICAGO AVE STE L21
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2326
Country	:	US
Telephone Number	:	517-827-0009
Fax Number	:	877-310-1729

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

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	02/26/2024

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