Active NPI
Luke James Camarillo
- Registered Nurse
- San Bruno, CA
National Provider Identifier
1306266655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 823814
- Practice address
- 1001 Sneath LN Ste 307
San Bruno, CA 94066-2349 - Phone
- (650) 922-4578
- Fax
- (650) 244-1447
- NPI assigned
- Apr 24, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Nurse Specialist | 364S00000X | 823814 | CA | |
| Registered Nurse | 163W00000X | 823814 | CA | Primary |
Addresses
Primary practice location
1001 Sneath LN Ste 307
San Bruno, CA 94066-2349
Mailing address
1001 Sneath LN Ste 307
San Bruno, CA 94066-2349
Phone (650) 922-4578
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38472 | Other | CA | THE LATINO COMMISSION ADMINISTRATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 823814 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562025600000",
"number": "1306266655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 SNEATH LN STE 307",
"city": "SAN BRUNO",
"state": "CA",
"postal_code": "940662349",
"telephone_number": "650-922-4578",
"fax_number": "650-244-1447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 SNEATH LN STE 307",
"city": "SAN BRUNO",
"state": "CA",
"postal_code": "940662349",
"telephone_number": "650-922-4578",
"fax_number": "650-244-1447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMARILLO",
"first_name": "LUKE",
"middle_name": "JAMES",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-04-24",
"last_updated": "2019-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "364S00000X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist",
"state": "CA",
"license": "823814",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "823814",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THE LATINO COMMISSION ADMINISTRATION",
"identifier": "38472",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bruno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.