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General NPI Number Information
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NPI Number | 1982352332
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Entity Type | Individual
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Provider Name | ESTEBAN GABRIEL CAMPOS PTA
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Gender | Male
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 2502 W FREDDY GONZALEZ DR STE B
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City | EDINBURG
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State | TX
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Zip | 78539-7388
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Country | US
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Telephone | 956-381-1600
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Fax | 956-381-1616
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Provider Business Mailing Address
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Address Line | 2101 N 23RD ST
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City | MCALLEN
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State | TX
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Zip | 78501-6127
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Country | US
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Telephone | 956-687-4560
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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