MEDICARE: MISS KOREANA 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1619172582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KOREANA CAMPOS

Provider Business Mailing Address
First Line	:	5232 E FALLS VIEW DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5232 E FALLS VIEW DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-1421
Country	:	US
Telephone Number	:	760-985-7933
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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Directions to “ MISS KOREANA CAMPOS ” Practice Location

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