Provider Demographics
NPI:1013965920
Name:ALBERTO X. CAMPAIN, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:ALBERTO X. CAMPAIN, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:X
Authorized Official - Last Name:CAMPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-528-1090
Mailing Address - Street 1:4940 VAN NUYS BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1741
Mailing Address - Country:US
Mailing Address - Phone:818-528-1090
Mailing Address - Fax:818-528-1099
Practice Address - Street 1:4940 VAN NUYS BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1741
Practice Address - Country:US
Practice Address - Phone:818-528-1090
Practice Address - Fax:818-528-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A294230Medicaid
CA00A294230Medicaid