Healthcare Provider Details

I. General information

NPI: 1407592561
Provider Name (Legal Business Name): LORA BETRON CAMPOS NP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22817 AVENUE 196
STRATHMORE CA
93267
US

IV. Provider business mailing address

24075 CORTE LA BROCHA
VALENCIA CA
91354-4004
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 747-253-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberNP95019171
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95019171
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95069985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: