Provider Demographics
NPI:1679316749
Name:CAMERON, TONY JORDAN JR
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:JORDAN
Last Name:CAMERON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ROYAL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3700
Mailing Address - Country:US
Mailing Address - Phone:626-879-7991
Mailing Address - Fax:
Practice Address - Street 1:236 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-2967
Practice Address - Country:US
Practice Address - Phone:323-924-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty