Provider Demographics
NPI:1306266655
Name:CAMARILLO, LUKE JAMES
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:JAMES
Last Name:CAMARILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SNEATH LN STE 307
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:650-922-4578
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:1001 SNEATH LN STE 307
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2349
Practice Address - Country:US
Practice Address - Phone:650-922-4578
Practice Address - Fax:650-244-1447
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA823814364S00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38472OtherTHE LATINO COMMISSION ADMINISTRATION
CA38241OtherHORIZONS SUBSTANCE ABUSE