Provider Demographics
NPI:1881878684
Name:CAMPOS, LORNA I (RD)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:I
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB CROWN HILLS
Mailing Address - Street 2:#161 CARITE ST
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-765-9765
Mailing Address - Fax:
Practice Address - Street 1:EDIF. CAPARRA GALLERY SUITE 204
Practice Address - Street 2:AVE. GONZALEZ GIUSTI #107, ESQ. MARTINEZ NADAL
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-782-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered