Provider Demographics
NPI:1649543984
Name:CAMPOS, VICTOR
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CAMPOS CONSTRUCTION
Other - Middle Name:
Other - Last Name:VC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11889 IMPERIAL GEM AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0297
Mailing Address - Country:US
Mailing Address - Phone:915-549-2486
Mailing Address - Fax:915-849-5832
Practice Address - Street 1:11889 IMPERIAL GEM AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0297
Practice Address - Country:US
Practice Address - Phone:915-549-2486
Practice Address - Fax:915-849-5832
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications