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NPI Code Detail

MEDICARE: MR. JACOB RANGEL CAMPOS CDCA

MEDICARE: MR. JACOB RANGEL CAMPOS CDCA
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1417342940
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACOB RANGEL CAMPOS CDCA
Provider Business Mailing Address
First Line : 1827 BONNIE BRAE AVE NE
Second Line :
City : WARREN
State : OH
Zip : 44483-3513
Country : US
Telephone Number : 330-719-9361
Fax Number :
Provider Business Practice Location Address
First Line : 2737 YOUNGSTOWN RD SE
Second Line :
City : WARREN
State : OH
Zip : 44484-5002
Country : US
Telephone Number : 330-369-8022
Fax Number : 330-800-3554
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2015
Last Update Date : 03/22/2016

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