Healthcare Provider Details

I. General information

NPI: 1124453808
Provider Name (Legal Business Name): MARIA AURORA CAMPA HUERGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10508 GIBSONTON DR
RIVERVIEW FL
33578-5434
US

IV. Provider business mailing address

10508 GIBSONTON DR
RIVERVIEW FL
33578-5434
US

V. Phone/Fax

Practice location:
  • Phone: 813-741-2100
  • Fax: 813-741-2003
Mailing address:
  • Phone: 813-741-2100
  • Fax: 813-741-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN513
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number020509
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: