Healthcare Provider Details

I. General information

NPI: 1538651385
Provider Name (Legal Business Name): CAROLINE ROBERTA CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 BEARD RD STE 1
NAPA CA
94558-3466
US

IV. Provider business mailing address

3260 BEARD RD STE 1
NAPA CA
94558-3466
US

V. Phone/Fax

Practice location:
  • Phone: 707-622-0481
  • Fax: 707-261-0756
Mailing address:
  • Phone: 707-622-0481
  • Fax: 707-261-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA201353
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number299765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: