Basic Information
| Provider Information | |||||||||
| NPI: | 1578887337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANDLER | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | YVETTE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E CHURCH ST | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393114 | ||||||||
| FaxNumber: | 8057393502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 PEACH ST STE A | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934012871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055434043 | ||||||||
| FaxNumber: | 8055437640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2010 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO162164 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OP60370105 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 20A12124 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.