Provider Demographics
NPI:1184492100
Name:CAMPOS, VIRGINIA I (NP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:I
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 EAST CLARK AVE
Mailing Address - Street 2:SUITE 150- 114
Mailing Address - City:ORCUTT
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5178
Mailing Address - Country:US
Mailing Address - Phone:805-934-5140
Mailing Address - Fax:
Practice Address - Street 1:915 E STOWELL RD STE C
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7010
Practice Address - Country:US
Practice Address - Phone:805-934-5140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine