Basic Information
| Provider Information | |||||||||
| NPI: | 1245288034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPOS | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2185 N LINWOOD ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932918603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597917047 | ||||||||
| FaxNumber: | 5597818193 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 NORTH PALM STREET | ||||||||
| Address2: | |||||||||
| City: | WOODLAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932861422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595640100 | ||||||||
| FaxNumber: | 5595642285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 11/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A90846 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.