MEDICARE: MRS. CAMILLE VERDUGO

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1629297080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMILLE VERDUGO

Provider Business Mailing Address
First Line	:	2631 E OLIVINE RD
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85243-4901
Country	:	US
Telephone Number	:	480-330-8314
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 N 3RD ST
Second Line	:	STE. 4000
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1129
Country	:	US
Telephone Number	:	602-200-9494
Fax Number	:	602-957-4785

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. CAMILLE VERDUGO ” Practice Location

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