Individual
CAMILLE RENEE RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
309 E 2ND ST, POMONA, CA 91766-1854
(909) 623-6116
Mailing address
306 N BASILIO AVE, SAN DIMAS, CA 91773-2707
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA58675
CA
363A00000X
Physician Assistant
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—
Other
Enumeration date
07/30/2020
Last updated
09/26/2023
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