Healthcare Provider Details

I. General information

NPI: 1679508360
Provider Name (Legal Business Name): CRYSTAL CAMPOS VALLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL CAMPOS MD

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 SARATOGA BLVD STE 150
CORPUS CHRISTI TX
78414-4252
US

IV. Provider business mailing address

919 HIDDEN RDG
IRVING TX
75038-3813
US

V. Phone/Fax

Practice location:
  • Phone: 361-986-4600
  • Fax: 361-985-0305
Mailing address:
  • Phone: 469-282-2711
  • Fax: 469-282-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM0029
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: