Provider Demographics
NPI:1033820865
Name:CAMPOS, ANTHONY RAY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RAY
Last Name:CAMPOS
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 1:258 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5950
Mailing Address - Country:US
Mailing Address - Phone:562-445-9838
Mailing Address - Fax:
Practice Address - Street 1:10625 LEFFINGWELL RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3434
Practice Address - Country:US
Practice Address - Phone:562-864-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38313227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38313OtherSTATE OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS