Basic Information
| Provider Information | |||||||||
| NPI: | 1275909079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPA | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ED.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CAMPA | ||||||||
| OtherFirstName: | DANNY | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ED.S. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 33305 1ST WAY S | ||||||||
| Address2: | SUITE# B203 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532355956 | ||||||||
| FaxNumber: | 2532355957 | ||||||||
| Practice Location | |||||||||
| Address1: | 33305 1ST WAY S | ||||||||
| Address2: | SUITE# B203 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532355956 | ||||||||
| FaxNumber: | 2532355957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2015 | ||||||||
| LastUpdateDate: | 08/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.