Provider Demographics
NPI:1407365323
Name:CAMPOS, BRANDON ANALU (LMT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ANALU
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-915 KUAEEWA PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4029
Mailing Address - Country:US
Mailing Address - Phone:808-741-1809
Mailing Address - Fax:
Practice Address - Street 1:91-915 KUAEEWA PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4029
Practice Address - Country:US
Practice Address - Phone:808-741-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist