Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | BP10032064 | TX |
NPI | 1003075714 |
---|---|
Provider Name | Dr. Michelle Grino Campana |
First Address | Valencia, CA 91355-9513 |
Second Address | Valencia, CA 91355-9513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 05/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2195077 | (05) | LA |