Healthcare Provider Details

I. General information

NPI: 1063344620
Provider Name (Legal Business Name): STEVEN JOHN CAMPOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S 7TH ST
EL CENTRO CA
92243-3919
US

IV. Provider business mailing address

1256 BROADWAY AVE
EL CENTRO CA
92243-2317
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-4791
  • Fax:
Mailing address:
  • Phone: 760-352-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: