Provider Demographics
NPI:1508217399
Name:CAMPOS, PRISCILLA JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:JUDITH
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58383 29 PALMS HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5891
Mailing Address - Country:US
Mailing Address - Phone:760-365-9305
Mailing Address - Fax:
Practice Address - Street 1:58383 29 PALMS HWY STE 101
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5891
Practice Address - Country:US
Practice Address - Phone:760-365-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA152651207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine