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General NPI Number Information
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NPI Number | 1114831609
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Entity Type | Individual
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Provider Name | OLVIMAR CAMPOS PA
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Gender | Female
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 1507 AVE PONCE DE LEON APT 205
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City | SAN JUAN
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State | PR
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Zip | 00909-2050
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Country | US
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Telephone | 939-475-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 AVE PONCE DE LEON APT 1445
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City | SAN JUAN
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State | PR
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Zip | 00909-2015
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Country | US
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Telephone | 787-461-4793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3248
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License Number State | PR
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