Provider Demographics
NPI:1043519689
Name:MARTIN DEL CAMPO, ALONSO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALONSO
Middle Name:JOSE
Last Name:MARTIN DEL CAMPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:ALONSO
Other - Last Name:MARTIN DEL CAMPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:68 SE 6TH ST APT 3908
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7171 SW 62ND AVE FL 3
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4723
Practice Address - Country:US
Practice Address - Phone:305-740-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127333207Q00000X
FLME138493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine