Provider Demographics
NPI:1164429577
Name:CAMPOS-LOPEZ, CARLOS JAVIER (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:JAVIER
Last Name:CAMPOS-LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 FANNIN ST STE A3300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2373
Mailing Address - Country:US
Mailing Address - Phone:832-824-1000
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-5800
Practice Address - Fax:832-825-5801
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4277207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151021603Medicaid
TX151021603Medicaid
TX8L5277Medicare PIN
TX8C7966Medicare ID - Type Unspecified