Provider Demographics
NPI:1295376861
Name:CAMPOS, MERILYN PATRICIA (LVN)
Entity Type:Individual
Prefix:
First Name:MERILYN
Middle Name:PATRICIA
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MISS
Other - First Name:MERILYN
Other - Middle Name:PATRICIA
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:21200 KITTRIDGE ST APT 2155
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3058
Mailing Address - Country:US
Mailing Address - Phone:818-312-6595
Mailing Address - Fax:
Practice Address - Street 1:4434 HARDING AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6123
Practice Address - Country:US
Practice Address - Phone:310-988-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276831164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse