Basic Information
| Provider Information | |||||||||
| NPI: | 1376564450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPWALA | ||||||||
| FirstName: | KHOZEMA | ||||||||
| MiddleName: | HATIM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3765 HEDGE LN | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930127753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054828725 | ||||||||
| FaxNumber: | 8054828725 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 WEST MAIN STREET | ||||||||
| Address2: | SUITE E | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056672850 | ||||||||
| FaxNumber: | 8056520708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 06/20/2012 | ||||||||
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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 | A81807 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.