Healthcare Provider Details

I. General information

NPI: 1699472274
Provider Name (Legal Business Name): CAMPOS MENTAL HEALTH CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 W 49TH PL STE 301
HIALEAH FL
33012-8131
US

IV. Provider business mailing address

1490 W 49TH PL STE 301
HIALEAH FL
33012-8131
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-9499
  • Fax:
Mailing address:
  • Phone: 305-776-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JORGE RODRIGUEZ CAMPO
Title or Position: PRESIDENT
Credential:
Phone: 305-776-9499