Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 52256 | AZ |
NPI | 1053653113 |
---|---|
Provider Name | Amanda Marie Campos |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006-1464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 26/09/2019 |