Provider Demographics
NPI:1376760173
Name:CAMPOS, ORLANDO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:ANTONIO
Last Name:CAMPOS
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:FARAYON 3313
Mailing Address - Street 2:ALTURAS DE MAYAGUEZ
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:787-831-5479
Mailing Address - Fax:787-831-5479
Practice Address - Street 1:52 CALLE DE DIEGO W
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4733
Practice Address - Country:US
Practice Address - Phone:787-831-5479
Practice Address - Fax:787-831-5479
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5224208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5224OtherLIC.
PR4191-3OtherASSMCA
PR4191-3OtherASSMCA
PRE-31454Medicare UPIN
PR0026362Medicare ID - Type Unspecified