Provider Demographics
NPI:1558361618
Name:CAMPOS HERRERA, LOIDA H
Entity Type:Individual
Prefix:
First Name:LOIDA
Middle Name:H
Last Name:CAMPOS HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CALLE NORZAGARAY
Mailing Address - Street 2:APT 3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1227
Mailing Address - Country:US
Mailing Address - Phone:787-460-2837
Mailing Address - Fax:
Practice Address - Street 1:502 CALLE NORZAGARAY
Practice Address - Street 2:APT 3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1227
Practice Address - Country:US
Practice Address - Phone:787-460-2837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH83471Medicare UPIN