Provider Demographics
NPI:1154862043
Name:CAMPUZANO, HECTOR
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:CAMPUZANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 BOSTON ROAD
Mailing Address - Street 2:UNIVERSAL CAR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-405-5555
Mailing Address - Fax:
Practice Address - Street 1:2530 BOSTON RD
Practice Address - Street 2:UNIVERSALCAR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9004
Practice Address - Country:US
Practice Address - Phone:718-405-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi