MEDICARE: ELIZABET CAMPOS

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	106S00000X	Behavior Technician		NM

General Provider Information

NPI Number	:	1295420156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABET CAMPOS

Provider Business Mailing Address
First Line	:	132 WINSTON DR
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-5804
Country	:	US
Telephone Number	:	505-507-4203
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 WINSTON DR
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-5804
Country	:	US
Telephone Number	:	505-507-4203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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Directions to “ ELIZABET CAMPOS ” Practice Location

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