Provider Demographics
NPI:1457664062
Name:CAMPOS, PAUL ISAAC (NP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ISAAC
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5127 W NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8354
Mailing Address - Country:US
Mailing Address - Phone:559-713-6515
Mailing Address - Fax:559-713-6516
Practice Address - Street 1:5127 W NOBLE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8354
Practice Address - Country:US
Practice Address - Phone:559-713-6515
Practice Address - Fax:559-713-6516
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA173363Medicare PIN