Provider Demographics
NPI:1366737918
Name:CAMPOS, JUAN MORENO
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MORENO
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-5423
Mailing Address - Country:US
Mailing Address - Phone:713-202-2857
Mailing Address - Fax:713-672-1758
Practice Address - Street 1:7226 MARKET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-5423
Practice Address - Country:US
Practice Address - Phone:713-202-2857
Practice Address - Fax:713-672-1758
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications