MEDICARE: DR. CAMILLE VELASCO SANTOS M.D.

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	207Q00000X	Family Medicine Physician	A97188	CA

General Provider Information

NPI Number	:	1699971184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMILLE VELASCO SANTOS M.D.

Provider Business Mailing Address
First Line	:	16918 DOVE CANYON RD
Second Line	:	SUITE #100
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3501
Country	:	US
Telephone Number	:	858-924-1900
Fax Number	:	858-924-1948

Provider Business Practice Location Address
First Line	:	16918 DOVE CANYON RD
Second Line	:	SUITE #100
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3501
Country	:	US
Telephone Number	:	858-924-1900
Fax Number	:

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	10/31/2012

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