Healthcare Provider Details

I. General information

NPI: 1568312601
Provider Name (Legal Business Name): OLGA LIDIA CAMPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W AMADOR AVE
LAS CRUCES NM
88005-2739
US

IV. Provider business mailing address

PO BOX 2243
LAS CRUCES NM
88004-2243
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9681
  • Fax: 575-652-3785
Mailing address:
  • Phone: 575-527-5482
  • Fax: 575-652-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: