Individual
CAMIA CUSTODIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 S 4TH ST, SAN JOSE, IL 62682-9527
(309) 247-1203
Mailing address
301 S 4TH ST, SAN JOSE, IL 62682-9527
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/09/2013
Last updated
05/17/2026
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