Healthcare Provider Details

I. General information

NPI: 1104634575
Provider Name (Legal Business Name): CAMPO VALDES ALGOS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E BROWARD BLVD APT 112
FT LAUDERDALE FL
33301-2139
US

IV. Provider business mailing address

1515 E BROWARD BLVD APT 112
FT LAUDERDALE FL
33301-2139
US

V. Phone/Fax

Practice location:
  • Phone: 305-467-0859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN DAVID BLANDON
Title or Position: PRESIDENT
Credential: PHD
Phone: 305-467-0859