Healthcare Provider Details

I. General information

NPI: 1437771300
Provider Name (Legal Business Name): JUAN JOSE SILVA CAMPOS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE S2 TOWER F PATHOLOGY
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1995
  • Fax: 505-841-1373
Mailing address:
  • Phone: 505-841-1995
  • Fax: 505-841-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD2026-0088
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: