Healthcare Provider Details

I. General information

NPI: 1912818873
Provider Name (Legal Business Name): CAMPILLO HEALTHCARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 NW 82ND AVE STE 400-10
DORAL FL
33166-6652
US

IV. Provider business mailing address

6540 W 13TH CT
HIALEAH FL
33012-6343
US

V. Phone/Fax

Practice location:
  • Phone: 786-374-6540
  • Fax:
Mailing address:
  • Phone: 786-374-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALCIDES CAMPILLO
Title or Position: PRESIDENT
Credential: APRN
Phone: 786-374-6540