Healthcare Provider Details

I. General information

NPI: 1396769238
Provider Name (Legal Business Name): WILLIFRED AMELIA CAMPBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 TORRANCE BLVD SECOND FLOOR
REDONDO BEACH CA
90277-3416
US

IV. Provider business mailing address

601 TORRANCE BLVD SECOND FLOOR
REDONDO BEACH CA
90277-3416
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-0811
  • Fax: 310-540-9587
Mailing address:
  • Phone: 310-316-0811
  • Fax: 310-540-9587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG060959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: