Provider Demographics
NPI:1952507014
Name:CAMPOSANO, MARIA CECILIA LABOR
Entity Type:Individual
Prefix:
First Name:MARIA CECILIA
Middle Name:LABOR
Last Name:CAMPOSANO
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 1:3609 MATLOCK PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1917
Mailing Address - Country:US
Mailing Address - Phone:540-538-3618
Mailing Address - Fax:
Practice Address - Street 1:1 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9357
Practice Address - Country:US
Practice Address - Phone:301-934-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility