Provider Demographics
NPI:1306568498
Name:DOSZTAN-CAMPBELL, STEPHANIE (RT (R)/CCMA/CPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:DOSZTAN-CAMPBELL
Suffix:
Gender:F
Credentials:RT (R)/CCMA/CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 KRYPTON DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3140
Mailing Address - Country:US
Mailing Address - Phone:805-708-2793
Mailing Address - Fax:
Practice Address - Street 1:7533 KRYPTON DR
Practice Address - Street 2:
Practice Address - City:CORP CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3140
Practice Address - Country:US
Practice Address - Phone:805-708-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1207247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist