Active NPI
Ivon Campo, M
- Specialist
- Anaheim, CA
National Provider Identifier
1306835947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- C43138
- Practice address
- 3055 W Orange Ave
Suite 202
Anaheim, CA 92804-3159 - Phone
- (714) 527-1262
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | C43138 | CA | Primary |
Addresses
Primary practice location
3055 W Orange Ave
Suite 202
Anaheim, CA 92804-3159
Mailing address
3055 W Orange Ave
Suite 202
Anaheim, CA 92804-3159
Phone (714) 527-1262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A348130 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358985600000",
"number": "1306835947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3055 W ORANGE AVE",
"address_2": "SUITE 202",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928043159",
"telephone_number": "714-527-1262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3055 W ORANGE AVE",
"address_2": "SUITE 202",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928043159",
"telephone_number": "714-527-1262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPO",
"first_name": "IVON",
"credential": "M",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2013-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "C43138",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A348130",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.