Individual
ILIANA CANDELARIA CAMPOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
602 N VIRGINIA ST, PORT LAVACA, TX 77979-3022
(361) 482-7827
Mailing address
602, N VIRGINIA ST UNITED B, PORT LAVACA, TX 77979
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT144378
TX
Other
Enumeration date
03/04/2025
Last updated
03/04/2025
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