Healthcare Provider Details

I. General information

NPI: 1699643247
Provider Name (Legal Business Name): GUILLERMINA CAMPOS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 NASHVILLE CT
POMONA CA
91768-1298
US

IV. Provider business mailing address

1241 NASHVILLE CT
POMONA CA
91768-1298
US

V. Phone/Fax

Practice location:
  • Phone: 909-973-2759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number462163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: