Provider Demographics
NPI:1245230945
Name:MARTINEZ-CAMPOS, RAQUEL MARIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:MARIA
Last Name:MARTINEZ-CAMPOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21422 CALLE SENDERO
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2157
Mailing Address - Country:US
Mailing Address - Phone:949-916-9618
Mailing Address - Fax:
Practice Address - Street 1:252E BERK HL
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-3959
Practice Address - Country:US
Practice Address - Phone:949-824-4274
Practice Address - Fax:949-824-0470
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN424425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily