Provider Demographics
NPI:1366921439
Name:CAMUS, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:CAMUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 NEW LOS ANGELES AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2078
Mailing Address - Country:US
Mailing Address - Phone:805-876-4176
Mailing Address - Fax:805-290-1994
Practice Address - Street 1:530 NEW LOS ANGELES AVE STE 103
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2078
Practice Address - Country:US
Practice Address - Phone:805-876-4176
Practice Address - Fax:805-290-1994
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist