Basic Information
| Provider Information | |||||||||
| NPI: | 1073578134 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAMRAS AND POLANSKY MEDICAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAMELLIA WOMEN'S HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5821 JAMESON CT | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164860411 | ||||||||
| FaxNumber: | 9164860525 | ||||||||
| Practice Location | |||||||||
| Address1: | 5821 JAMESON CT | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164860411 | ||||||||
| FaxNumber: | 9164860525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 10/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | PAYNE | ||||||||
| AuthorizedOfficialFirstName: | PATTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9164860411 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | YYY49032Y | 05 | CA | MEDICAID |