Provider Demographics
NPI:1588877666
Name:CAMPOMANES, ILDEFONSO TIMPLE III (PT)
Entity type:Individual
Prefix:MR
First Name:ILDEFONSO
Middle Name:TIMPLE
Last Name:CAMPOMANES
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5704
Mailing Address - Country:US
Mailing Address - Phone:707-263-4564
Mailing Address - Fax:707-263-4572
Practice Address - Street 1:2838 OSWELL ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-2704
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:661-616-6199
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic