Provider Demographics
NPI:1831627371
Name:CAMPILLO MEDICAL CORP
Entity type:Organization
Organization Name:CAMPILLO MEDICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPILLO-JUIG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, LHHC
Authorized Official - Phone:305-300-5551
Mailing Address - Street 1:6583 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4821
Mailing Address - Country:US
Mailing Address - Phone:786-615-3187
Mailing Address - Fax:786-756-1010
Practice Address - Street 1:6583 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4821
Practice Address - Country:US
Practice Address - Phone:786-615-3187
Practice Address - Fax:786-756-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-29
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105-282-500Medicaid