Provider Demographics
NPI:1508418682
Name:CAMPILLO MEDICAL WELLNESS CORP
Entity Type:Organization
Organization Name:CAMPILLO MEDICAL WELLNESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-5551
Mailing Address - Street 1:6355 SW 8TH ST STE 5E
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4858
Mailing Address - Country:US
Mailing Address - Phone:305-300-5551
Mailing Address - Fax:
Practice Address - Street 1:6355 SW 8TH ST STE 5E
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4858
Practice Address - Country:US
Practice Address - Phone:305-300-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty