Healthcare Provider Details

I. General information

NPI: 1588877666
Provider Name (Legal Business Name): ILDEFONSO TIMPLE CAMPOMANES III P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2838 OSWELL ST
BAKERSFIELD CA
93306-2704
US

IV. Provider business mailing address

1281 CRAIG AVE
LAKEPORT CA
95453-5704
US

V. Phone/Fax

Practice location:
  • Phone: 661-377-1700
  • Fax: 661-616-6199
Mailing address:
  • Phone: 707-263-4564
  • Fax: 707-263-4572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number34058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: