Provider Demographics
NPI:1427105618
Name:CAMPOVERDE, FERNANDO (LSA)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:CAMPOVERDE
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820072
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77282-0072
Mailing Address - Country:US
Mailing Address - Phone:832-421-7828
Mailing Address - Fax:
Practice Address - Street 1:16750 RED OAK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2543
Practice Address - Country:US
Practice Address - Phone:281-453-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00273363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical