Provider Demographics
NPI:1265626600
Name:BERRERA CAMPOS, CYNTHIA B (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:BERRERA CAMPOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:B
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4049 EISENHOWER ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1100
Mailing Address - Country:US
Mailing Address - Phone:972-898-1217
Mailing Address - Fax:314-856-1554
Practice Address - Street 1:4049 EISENHOWER ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1100
Practice Address - Country:US
Practice Address - Phone:972-898-1217
Practice Address - Fax:314-856-1554
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581446171M00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management