Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | SPF0000030 | CA |
N | 208000000X | Pediatrician | SPF0000030 | CA |
NPI | 1598141475 |
---|---|
Provider Name | Miguel Del Campo Casanelles |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-2736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2015 |
Last Update Date | 03/08/2015 |