Provider Demographics
NPI:1831158633
Name:ESTRADA CAMPOS, NAOMI M (MD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:M
Last Name:ESTRADA CAMPOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NAOMI
Other - Middle Name:M
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9326 VISTA CLARA LOOP NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2299
Mailing Address - Country:US
Mailing Address - Phone:505-899-3954
Mailing Address - Fax:
Practice Address - Street 1:3436 ISLETA BLVD SW
Practice Address - Street 2:PRESBYTERIAN MEDICAL GROUP
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105
Practice Address - Country:US
Practice Address - Phone:505-462-7777
Practice Address - Fax:505-462-7774
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG71452Medicare UPIN
NM8HBT91Medicare ID - Type Unspecified