Provider Demographics
NPI:1053145094
Name:CAMPBELL, LEIGHTON
Entity type:Individual
Prefix:MR
First Name:LEIGHTON
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4471 W ADAMS BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-3083
Mailing Address - Country:US
Mailing Address - Phone:310-904-2655
Mailing Address - Fax:424-672-7267
Practice Address - Street 1:4471 W ADAMS BLVD APT 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-3083
Practice Address - Country:US
Practice Address - Phone:310-904-2655
Practice Address - Fax:424-672-7267
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)