| Doctor Name: | EDWARD CAMPOS |
| NPI Number: | 1912301839 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | M-08762 |
| Business Practice Address: | 1607 W Aztec Blvd Aztec, NM - 874101805 |
| Business Phone Number: | 5053343695 |
| Business Fax Number: | |
| Mailing Address: | 1607 W Aztec Blvd, AZTEC |
| State: | NM |
| Postal Code: | 874101805 |
| Phone Number: | 5053343695 |
| Fax Number: | |
| NPI Enumeration Date: | 10/21/2014 |
| NPI Last Update Date: | 10/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | M-08762 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |