Provider Demographics
NPI:1427894336
Name:DEL CAMPO, JANICA REYES
Entity type:Individual
Prefix:MS
First Name:JANICA
Middle Name:REYES
Last Name:DEL CAMPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 56TH AVE APT 3V
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4903
Mailing Address - Country:US
Mailing Address - Phone:929-454-7581
Mailing Address - Fax:
Practice Address - Street 1:17119 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4548
Practice Address - Country:US
Practice Address - Phone:929-454-7581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist