Provider Demographics
NPI:1467650978
Name:CAMPOS, JOSE T (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:T
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1650 UNIVERSITY BLVD NE
Mailing Address - Street 2:STE. 116
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1726
Mailing Address - Country:US
Mailing Address - Phone:505-272-8950
Mailing Address - Fax:505-272-3202
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-8950
Practice Address - Fax:505-272-3202
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2023-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2006-0039363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical