Provider Demographics
NPI:1629663133
Name:CAMPUZANO, OSCAR ORLANDO JR (STUDENT)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:ORLANDO
Last Name:CAMPUZANO
Suffix:JR
Gender:M
Credentials:STUDENT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:500 W THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4255
Practice Address - Country:US
Practice Address - Phone:602-406-1510
Practice Address - Fax:602-406-7277
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ8774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program