Provider Demographics
NPI:1073850194
Name:CAMPOS TRIANA, ANGELITZA C (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELITZA
Middle Name:C
Last Name:CAMPOS TRIANA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 SAN JUAN DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6224
Mailing Address - Country:US
Mailing Address - Phone:305-458-2805
Mailing Address - Fax:
Practice Address - Street 1:751 SAN JUAN DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-6224
Practice Address - Country:US
Practice Address - Phone:305-458-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist