Healthcare Provider Details

I. General information

NPI: 1831920438
Provider Name (Legal Business Name): LUIS JESUS CAMPOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S CENTRAL ST
VISALIA CA
93277-4418
US

IV. Provider business mailing address

1840 S CENTRAL ST
VISALIA CA
93277-4418
US

V. Phone/Fax

Practice location:
  • Phone: 559-471-4050
  • Fax:
Mailing address:
  • Phone: 559-471-4050
  • Fax: 559-390-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: