MEDICARE: ALBERTO X. CAMPAIN, M.D., A PROFESSIONAL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A29432	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013965920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERTO X. CAMPAIN, M.D., A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	4940 VAN NUYS BLVD.
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-528-1090
Fax Number	:	818-528-1099

Provider Business Practice Location Address
First Line	:	4940 VAN NUYS BLVD.
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1741
Country	:	US
Telephone Number	:	818-528-1090
Fax Number	:	818-528-1099

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALBERTO X. CAMPAIN
Credential	:	M.D.
Telephone Number	:	818-528-1090

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/11/2011

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