Provider Demographics
NPI:1730222589
Name:CARLOS DEL CAMPO MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:CARLOS DEL CAMPO MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-446-8920
Mailing Address - Street 1:301 W BASTANCHURY RD
Mailing Address - Street 2:SUITE 195
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3419
Mailing Address - Country:US
Mailing Address - Phone:714-446-8920
Mailing Address - Fax:714-446-8923
Practice Address - Street 1:301 W BASTANCHURY RD
Practice Address - Street 2:SUITE 195
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3419
Practice Address - Country:US
Practice Address - Phone:714-446-8920
Practice Address - Fax:714-446-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52167208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A521670Medicaid
CAF68106Medicare UPIN
CAA52167Medicare ID - Type Unspecified