Provider Demographics
NPI:1679240394
Name:CAMPOS DE-IRWIN, MARIA ADELAIDA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ADELAIDA
Last Name:CAMPOS DE-IRWIN
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 1:3149 E DESERT INN RD APT 7
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3832
Mailing Address - Country:US
Mailing Address - Phone:702-782-3799
Mailing Address - Fax:
Practice Address - Street 1:3149 E DESERT INN RD APT 7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3832
Practice Address - Country:US
Practice Address - Phone:702-782-3799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant