Provider Demographics
NPI:1861693061
Name:CAMPOS, VICTOR IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:IVAN
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-01
Mailing Address - Street 2:BOX 12028
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-205-5743
Mailing Address - Fax:
Practice Address - Street 1:CALLE CARLOS J ANDALUZ #2 G14
Practice Address - Street 2:URB LOMAS VERDES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-205-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10531208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice