Active NPI
Carla Patricia Campo, DDS
- Dentist
- Lake Elsinore, CA
National Provider Identifier
1609012830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 57000
- Practice address
- 30195 Fraser Dr
Lake Elsinore, CA 92530-7006 - Phone
- (951) 252-2720
- NPI assigned
- Dec 17, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 57000 | CA | Primary |
Addresses
Primary practice location
30195 Fraser Dr
Lake Elsinore, CA 92530-7006
Mailing address
1000 Vale Terrace Dr
Vista, CA 92084-5218
Phone (760) 631-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871689315 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150602000409 | CA | Order and Referring Only - Dentist | 5597086611 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57000 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553126400000",
"number": "1609012830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 VALE TERRACE DR",
"city": "VISTA",
"state": "CA",
"postal_code": "920845218",
"telephone_number": "760-631-5000",
"fax_number": "760-414-3702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30195 FRASER DR",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925307006",
"telephone_number": "951-252-2720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPO",
"first_name": "CARLA",
"middle_name": "PATRICIA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-17",
"last_updated": "2019-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "57000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1871689315",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Elsinore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.