Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | C20474 | CA |
NPI | 1316106396 |
---|---|
Provider Name | Charles A Camarata |
First Address | Chula Vista, CA 91910-3249 |
Second Address | Chula Vista, CA 91910-3249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 05/06/2008 |