Healthcare Provider Details

I. General information

NPI: 1336050020
Provider Name (Legal Business Name): MICHELLE CAMPOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

IV. Provider business mailing address

10326 EL REY DR
WHITTIER CA
90606-1023
US

V. Phone/Fax

Practice location:
  • Phone: 562-239-8254
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95419647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: