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NPI Code Detail

MEDICARE: CAMERON EBY RANDALL

MEDICARE: CAMERON EBY RANDALL
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912353780
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMERON EBY RANDALL
Provider Business Mailing Address
First Line : 14251 DANIELSON ST
Second Line :
City : POWAY
State : CA
Zip : 92064-8818
Country : US
Telephone Number : 858-699-7579
Fax Number : 858-726-6021
Provider Business Practice Location Address
First Line : 14251 DANIELSON ST
Second Line :
City : POWAY
State : CA
Zip : 92064-8818
Country : US
Telephone Number : 858-699-7579
Fax Number : 858-726-6021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2016
Last Update Date : 03/05/2020

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Directions to “ CAMERON EBY RANDALL ” Practice Location

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