Provider Demographics
NPI:1093545915
Name:MORI, CAMILLE (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:MORI
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 16TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-4443
Mailing Address - Country:US
Mailing Address - Phone:714-715-7983
Mailing Address - Fax:
Practice Address - Street 1:225 16TH ST APT B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-4443
Practice Address - Country:US
Practice Address - Phone:949-444-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86080702133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal