Healthcare Provider Details

I. General information

NPI: 1619472925
Provider Name (Legal Business Name): BERTHA CAMPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE STE 6006
MIAMI FL
33133-4221
US

IV. Provider business mailing address

3659 S MIAMI AVE STE 6006
MIAMI FL
33133-4221
US

V. Phone/Fax

Practice location:
  • Phone: 305-200-3878
  • Fax: 305-290-1017
Mailing address:
  • Phone: 305-200-3878
  • Fax: 305-290-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number318784
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME179867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: