MEDICARE: DR CAMPOS WELLNESS AND AESTHETICS

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
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1467187369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR CAMPOS WELLNESS AND AESTHETICS

Provider Business Mailing Address
First Line	:	10925 SW 26TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-2301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7261 SW 48TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5518
Country	:	US
Telephone Number	:	305-401-4153
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA CAMPOS
Credential	:	MD
Telephone Number	:	305-799-5526

Provider Enumeration Date	:	07/24/2022
Last Update Date	:	07/24/2022

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