MEDICARE: OCTAVIO ANTONIO CAMPOS CPRS

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	175T00000X	Peer Specialist	37317	IL

General Provider Information

NPI Number	:	1861261232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OCTAVIO ANTONIO CAMPOS CPRS

Provider Business Mailing Address
First Line	:	3471 MAIN HWY APT 929
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-5930
Country	:	US
Telephone Number	:	786-399-7375
Fax Number	:

Provider Business Practice Location Address
First Line	:	3471 MAIN HWY APT 929
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-5930
Country	:	US
Telephone Number	:	786-399-7375
Fax Number	:

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

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	01/23/2024

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