Provider Demographics
NPI:1801329214
Name:CAMPOS, LEONILA (RD)
Entity type:Individual
Prefix:
First Name:LEONILA
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LEONILA
Other - Middle Name:
Other - Last Name:RIVERA HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4115 W FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-9001
Mailing Address - Country:US
Mailing Address - Phone:919-961-7931
Mailing Address - Fax:
Practice Address - Street 1:4115 W FREMONT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-9001
Practice Address - Country:US
Practice Address - Phone:919-961-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered