Provider Demographics
NPI:1548518921
Name:CAMPOZANO, VICTOR IVAN
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:IVAN
Last Name:CAMPOZANO
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 1:558 W 181ST ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-5028
Mailing Address - Country:US
Mailing Address - Phone:646-421-9566
Mailing Address - Fax:
Practice Address - Street 1:558 W 181ST ST APT B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5028
Practice Address - Country:US
Practice Address - Phone:646-421-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist