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NPI Code Detail

MEDICARE: CLARICE CAMPOSANO CALOPIZ M.D.

MEDICARE: CLARICE CAMPOSANO CALOPIZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA92245CA
2207Q00000XFamily Medicine PhysicianMD177448OR

General Provider Information

NPI Number : 1316051410
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARICE CAMPOSANO CALOPIZ M.D.
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number : 503-215-6494
Fax Number :
Provider Business Practice Location Address
First Line : 5555 NE ELAM YOUNG PKWY
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-6452
Country : US
Telephone Number : 503-216-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 10/19/2020

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