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NPI Code Detail

MEDICARE: MR. FERNANDO CAMPOVERDE LSA

MEDICARE: MR. FERNANDO CAMPOVERDE LSA
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
1363AS0400XSurgical Physician AssistantSA00273TX

General Provider Information

NPI Number : 1427105618
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FERNANDO CAMPOVERDE LSA
Provider Business Mailing Address
First Line : PO BOX 820072
Second Line :
City : HOUSTON
State : TX
Zip : 77282-0072
Country : US
Telephone Number : 832-421-7828
Fax Number :
Provider Business Practice Location Address
First Line : 16750 RED OAK DR
Second Line :
City : HOUSTON
State : TX
Zip : 77090-2543
Country : US
Telephone Number : 281-453-7750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 01/31/2019

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