Provider Demographics
NPI:1053926220
Name:CAMPOS CALDERON, AINED (LMT)
Entity type:Individual
Prefix:
First Name:AINED
Middle Name:
Last Name:CAMPOS CALDERON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 PAT BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1840
Mailing Address - Country:US
Mailing Address - Phone:786-560-4929
Mailing Address - Fax:
Practice Address - Street 1:8310 PAT BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1840
Practice Address - Country:US
Practice Address - Phone:786-560-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA93787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist