=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245230945
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAQUEL MARIA MARTINEZ-CAMPOS N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 02/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 252E BERK HL
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92697-3959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-824-4274
-----------------------------------------------------
Fax | 949-824-0470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21422 CALLE SENDERO
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-2157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-916-9618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN424425
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------