Provider Demographics
NPI:1265478648
Name:CAMPA-GARCIA, IGNACIO (PA)
Entity Type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:
Last Name:CAMPA-GARCIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 W CHERRY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1125
Mailing Address - Country:US
Mailing Address - Phone:208-367-8550
Mailing Address - Fax:208-367-5464
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1668
Practice Address - Country:US
Practice Address - Phone:865-500-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100846363A00000X
IDPA-597363AM0700X
PAMA055359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical