Provider Demographics
NPI:1386083855
Name:CAMELO, MONICA STEPHANIE (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:STEPHANIE
Last Name:CAMELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 25561
Mailing Address - Street 2:FLEET SURGICAL TEAM NINE
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96661
Mailing Address - Country:US
Mailing Address - Phone:619-556-3590
Mailing Address - Fax:
Practice Address - Street 1:26520 CACTUS AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA136208208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program