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1588877666 NPI number — ILDEFONSO TIMPLE CAMPOMANES III P.T.

NPI Number: 1588877666
Health Care Provider/Practitioner: ILDEFONSO TIMPLE CAMPOMANES III P.T.

Information about “1588877666” NPI (ILDEFONSO TIMPLE CAMPOMANES III P.T.) exists in 1588877666 in HTML format HTML  |  1588877666 in plain Text format TXT  |  1588877666 in PDF (Portable Document Format) PDF  |  1588877666 in an XML format XML  formats.

NPI Number : 1588877666 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588877666",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CAMPOMANES",
    "FirstName": "ILDEFONSO",
    "MiddleName": "TIMPLE",
    "NamePrefix": "MR.",
    "NameSuffix": "III",
    "Credential": "P.T.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1281 CRAIG AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKEPORT",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95453-5704",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-263-4564",
    "MailingAddressFaxNumber": "707-263-4572",
    "FirstLinePracticeLocationAddress": "2838 OSWELL ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BAKERSFIELD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93306-2704",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "661-377-1700",
    "PracticeLocationAddressFaxNumber": "661-616-6199",
    "EnumerationDate": "05/07/2007",
    "LastUpdateDate": "04/25/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2251X0800X",
        "TaxonomyName": "Orthopedic Physical Therapist",
        "LicenseNumber": "34058",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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