Healthcare Provider Details

I. General information

NPI: 1013086743
Provider Name (Legal Business Name): LOURDES M DEL CAMPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

# 261 URB. CIUDAD JARDIN ST BAUHINIA
TOA ALTA PR
00953
US

IV. Provider business mailing address

# 261URB. CIUDAD JARDIN ST BAUHINIA
TOA ALTA PR
00953
US

V. Phone/Fax

Practice location:
  • Phone: 787-279-5111
  • Fax:
Mailing address:
  • Phone: 787-279-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9476
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: