Provider Demographics
NPI:1407592561
Name:CAMPOS, LORA BETRON (NP- BC)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:BETRON
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:NP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24075 CORTE LA BROCHA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-4004
Mailing Address - Country:US
Mailing Address - Phone:747-253-9940
Mailing Address - Fax:
Practice Address - Street 1:22817 AVENUE 196
Practice Address - Street 2:
Practice Address - City:STRATHMORE
Practice Address - State:CA
Practice Address - Zip Code:93267
Practice Address - Country:US
Practice Address - Phone:877-960-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95019171207V00000X, 363LF0000X
CA95069985163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health