Individual
CAMILLE WISSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5951 E VILLAGE CENTER LOOP RD, SAN DIEGO, CA 92130-2499
(858) 350-0253
Mailing address
4568 GEORGIA ST, SAN DIEGO, CA 92116-5607
(805) 452-1751
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000022564
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000022564
BOC
CA
Enumeration date
11/07/2017
Last updated
11/07/2017
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