Healthcare Provider Details

I. General information

NPI: 1477877272
Provider Name (Legal Business Name): DAVID S CAMPION MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 SANTA MONICA BLVD SUITE 210
LOS ANGELES CA
90025-4749
US

IV. Provider business mailing address

10780 SANTA MONICA BLVD SUITE 210
LOS ANGELES CA
90025-4749
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-5404
  • Fax: 310-275-6997
Mailing address:
  • Phone: 310-453-5404
  • Fax: 310-453-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA24908
License Number StateCA

VIII. Authorized Official

Name: DAVID S CAMPION
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-453-5404