Healthcare Provider Details

I. General information

NPI: 1356850978
Provider Name (Legal Business Name): RACHEL CONSUELO CAMPOS B.A., ASL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S MEADOWS RD
SANTA FE NM
87507-3601
US

IV. Provider business mailing address

1381 SANTA ROSA DR
SANTA FE NM
87505-3491
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-1300
  • Fax:
Mailing address:
  • Phone: 505-699-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number378855
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCF6386
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: