Healthcare Provider Details

I. General information

NPI: 1669496873
Provider Name (Legal Business Name): MARIBEL CAMPOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PEDIATRICS 1A-29 UNIVERSITY PEDIATRIC HOSPITAL
SAN JUAN PR
00936
US

IV. Provider business mailing address

PO BOX 70344 PMB #65
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-4010
  • Fax: 787-777-3227
Mailing address:
  • Phone: 787-777-3225
  • Fax: 787-758-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13254
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: