Healthcare Provider Details

I. General information

NPI: 1992907786
Provider Name (Legal Business Name): JOSE CAMPOS L.C.S.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 WALNUT SPRINGS DR
KATY TX
77449-6214
US

IV. Provider business mailing address

3008 WALNUT SPRINGS DR
KATY TX
77449-6214
US

V. Phone/Fax

Practice location:
  • Phone: 713-291-1363
  • Fax: 281-587-1720
Mailing address:
  • Phone: 713-291-1363
  • Fax: 281-587-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA00198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: