Healthcare Provider Details

I. General information

NPI: 1710066444
Provider Name (Legal Business Name): SARA E. CAMPOS MDPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E BUSTAMANTE ST STE D
LAREDO TX
78041-8905
US

IV. Provider business mailing address

1501 E BUSTAMANTE ST STE D
LAREDO TX
78041-8905
US

V. Phone/Fax

Practice location:
  • Phone: 956-795-4750
  • Fax: 956-795-4753
Mailing address:
  • Phone: 956-795-4750
  • Fax: 956-795-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ3290
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: