Healthcare Provider Details

I. General information

NPI: 1639089675
Provider Name (Legal Business Name): ERNESTO CAMPOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13221 SW 251ST LN
HOMESTEAD FL
33032-2539
US

IV. Provider business mailing address

13221 SW 251ST LN
HOMESTEAD FL
33032-2539
US

V. Phone/Fax

Practice location:
  • Phone: 786-273-0794
  • Fax:
Mailing address:
  • Phone: 786-273-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: