Provider Demographics
NPI:1447439609
Name:CARCAMO, CLAUDIA L (PA)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:L
Last Name:CARCAMO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17709 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5675
Mailing Address - Country:US
Mailing Address - Phone:818-836-3817
Mailing Address - Fax:
Practice Address - Street 1:17709 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5675
Practice Address - Country:US
Practice Address - Phone:818-363-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB247007Medicare PIN