Provider Demographics
NPI:1104634575
Name:CAMPO VALDES ALGOS, INC.
Entity type:Organization
Organization Name:CAMPO VALDES ALGOS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BLANDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-467-0859
Mailing Address - Street 1:1515 E BROWARD BLVD APT 112
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 E BROWARD BLVD APT 112
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2139
Practice Address - Country:US
Practice Address - Phone:305-467-0859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care