Provider Demographics
NPI:1558680009
Name:CAMPOS, MOSES (PA)
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 N CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4004
Mailing Address - Country:US
Mailing Address - Phone:956-580-9966
Mailing Address - Fax:956-580-1964
Practice Address - Street 1:1616 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4004
Practice Address - Country:US
Practice Address - Phone:956-580-9966
Practice Address - Fax:956-580-1964
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant