Provider Demographics
NPI:1023196599
Name:ZIOMEK, CAMILLE MARIE (MD,)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:MARIE
Last Name:ZIOMEK
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-0779
Mailing Address - Country:US
Mailing Address - Phone:209-373-2800
Mailing Address - Fax:209-373-2873
Practice Address - Street 1:131 W A ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3437
Practice Address - Country:US
Practice Address - Phone:707-635-1600
Practice Address - Fax:707-635-1641
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH87775Medicare ID - Type UnspecifiedFAMILY PRACTICE