Healthcare Provider Details

I. General information

NPI: 1548879919
Provider Name (Legal Business Name): ECKARDT W CAMPOS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10749 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2324
US

IV. Provider business mailing address

PO BOX 476
LOMA LINDA CA
92354-0476
US

V. Phone/Fax

Practice location:
  • Phone: 909-353-9828
  • Fax: 818-980-7144
Mailing address:
  • Phone: 915-300-7470
  • Fax: 909-798-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ECKARDT WILLIAM CAMPOS
Title or Position: CEO
Credential: MD
Phone: 909-353-9828