Provider Demographics
NPI:1861261232
Name:CAMPOS, OCTAVIO ANTONIO (CPRS)
Entity type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:ANTONIO
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 MAIN HWY APT 929
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5930
Mailing Address - Country:US
Mailing Address - Phone:786-399-7375
Mailing Address - Fax:
Practice Address - Street 1:3471 MAIN HWY APT 929
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5930
Practice Address - Country:US
Practice Address - Phone:786-399-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL37317175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist