Provider Demographics
NPI:1346221199
Name:CAMPISI, DAVID J (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:CAMPISI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1360 W 6TH ST
Mailing Address - Street 2:NORTH BLDG STE 315
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3514
Mailing Address - Country:US
Mailing Address - Phone:310-831-8952
Mailing Address - Fax:310-831-0568
Practice Address - Street 1:1360 W 6TH ST
Practice Address - Street 2:NORTH BLDG STE 315
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3514
Practice Address - Country:US
Practice Address - Phone:310-831-8952
Practice Address - Fax:310-831-0568
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-06-17
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Provider Licenses
StateLicense IDTaxonomies
CAG25065207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G250651Medicaid
CAWG25065CMedicare PIN
CA00G250651Medicaid