Provider Demographics
NPI:1154883940
Name:SHOAPOUR, CAMELLIA (MD)
Entity type:Individual
Prefix:DR
First Name:CAMELLIA
Middle Name:
Last Name:SHOAPOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMELIA
Other - Middle Name:
Other - Last Name:SHOAEPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26991 CROWN VALLEY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6511
Mailing Address - Country:US
Mailing Address - Phone:949-582-5430
Mailing Address - Fax:949-348-9513
Practice Address - Street 1:26991 CROWN VALLEY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6511
Practice Address - Country:US
Practice Address - Phone:949-582-5430
Practice Address - Fax:949-348-9513
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA180079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program