| Campillo Medical Corp | |
|
6583 Sw 39th Ter Miami FL 33155-4821 | |
| (786) 615-3187 | |
| (786) 756-1010 |
| Full Name | Campillo Medical Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 6583 Sw 39th Ter, Miami, Florida |
| Authorized Official Name and Position | Eric Campillo-juig (CLINICAL DIRECTOR) |
| Authorized Official Contact | 3053005551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Campillo Medical Corp 6583 Sw 39th Ter Miami FL 33155-4821 Ph: (786) 615-3187 | Campillo Medical Corp 6583 Sw 39th Ter Miami FL 33155-4821 Ph: (786) 615-3187 |
| NPI Number | 1831627371 |
|---|---|
| Provider Enumeration Date | 05/29/2017 |
| Last Update Date | 01/08/2021 |
| Certification Date | 01/08/2021 |
| Medicare PECOS PAC ID | 1951737832 |
|---|---|
| Medicare Enrollment ID | O20200213000254 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831627371 | NPI | - | NPPES |
| 105-282-500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
| Provider Name | Eric Rafael Campillo-juig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205039005 PECOS PAC ID: 6901173566 Enrollment ID: I20171220002705 |
| Provider Name | Kalvin Kapoor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861829392 PECOS PAC ID: 2163788902 Enrollment ID: I20180130001502 |
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