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General NPI Number Information
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NPI Number | 1588877666
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Entity Type | Individual
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Provider Name | ILDEFONSO TIMPLE CAMPOMANES III P.T.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 2838 OSWELL ST
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City | BAKERSFIELD
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State | CA
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Zip | 93306-2704
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Country | US
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Telephone | 661-377-1700
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Fax | 661-616-6199
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Provider Business Mailing Address
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Address Line | 1281 CRAIG AVE
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City | LAKEPORT
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State | CA
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Zip | 95453-5704
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Country | US
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Telephone | 707-263-4564
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Fax | 707-263-4572
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 34058
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License Number State | CA
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