Healthcare Provider Details

I. General information

NPI: 1093177180
Provider Name (Legal Business Name): YESICA ANDREA CAMPOS-CAMPOS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-8085
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2792
  • Fax: 860-679-1494
Mailing address:
  • Phone: 860-679-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1023116
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number066962
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number066962
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: