Provider Demographics
NPI:1407592561
Name:CAMPOS, LORA BETRON (NP- BC)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:BETRON
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:NP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W KIMBALL AVE APT B
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4176
Mailing Address - Country:US
Mailing Address - Phone:747-253-9940
Mailing Address - Fax:
Practice Address - Street 1:1600 E FLORIDA AVE STE 315
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8639
Practice Address - Country:US
Practice Address - Phone:951-765-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95069985163WH0200X
CANP95019171207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health