Provider Demographics
NPI:1003075714
Name:CAMPANA, MICHELLE GRINO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:GRINO
Last Name:CAMPANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE MICHELLE
Other - Middle Name:ANTONIO
Other - Last Name:GRINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:23823 VALENCIA BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-9513
Mailing Address - Country:US
Mailing Address - Phone:661-253-4971
Mailing Address - Fax:
Practice Address - Street 1:23823 VALENCIA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-9513
Practice Address - Country:US
Practice Address - Phone:661-253-4971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10032064208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2195077Medicaid