Individual
CARLA PATRICIA CAMPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
30195 FRASER DR, LAKE ELSINORE, CA 92530-7006
(951) 252-2720
Mailing address
1000 VALE TERRACE DR, VISTA, CA 92084-5218
(760) 631-5000
(760) 414-3702
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
57000
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871689315
—
CA
Enumeration date
12/17/2008
Last updated
03/21/2019
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