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General NPI Number Information
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NPI Number | 1417176397
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Entity Type | Organization
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Legal Business Name | CAMPILLO MEDICAL INC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1224 NW 29TH ST
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City | MIAMI
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State | FL
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Zip | 33142-6618
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Country | US
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Telephone | 305-636-2080
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Fax | 305-636-2015
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Provider Business Mailing Address
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Address Line | 1224 NW 29TH ST
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City | MIAMI
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State | FL
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Zip | 33142-6618
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Country | US
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Telephone | 305-636-2080
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Fax | 305-636-2015
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. LUIS M CAMPILLO
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Credential | MD
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Telephone | 305-636-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0064856
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License Number State | FL
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