MEDICARE: CRYSTAL CAMPOS VALLS M.D.

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	207Q00000X	Family Medicine Physician	M0029	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P02601740	OTHER	TX	MCRR

General Provider Information

NPI Number	:	1679508360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL CAMPOS VALLS M.D.

Provider Business Mailing Address
First Line	:	919 HIDDEN RDG
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3813
Country	:	US
Telephone Number	:	469-282-2711
Fax Number	:	469-282-0996

Provider Business Practice Location Address
First Line	:	5802 SARATOGA BLVD
Second Line	:	STE 150
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4252
Country	:	US
Telephone Number	:	361-986-4600
Fax Number	:	361-985-0305

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/09/2021

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