Healthcare Provider Details

I. General information

NPI: 1841732294
Provider Name (Legal Business Name): JESSICA KRISTIE CAMPOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 210
ORANGE CA
92868-3211
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6966
  • Fax: 714-456-8212
Mailing address:
  • Phone: 714-456-6966
  • Fax: 714-456-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA182197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: