Healthcare Provider Details

I. General information

NPI: 1235995432
Provider Name (Legal Business Name): JESSE LEE CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 22190 10TH ST
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

BLDG. 22190 10TH ST
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-3784
  • Fax:
Mailing address:
  • Phone: 760-725-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101286785
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: