Provider Demographics
NPI:1083341119
Name:CAMPOS, FREDDY A JR
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:A
Last Name:CAMPOS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FREDDY
Other - Middle Name:A
Other - Last Name:CAMPOS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4401 CRENSHAW BLVD STE 215L
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1227
Mailing Address - Country:US
Mailing Address - Phone:323-291-7100
Mailing Address - Fax:
Practice Address - Street 1:4401 CRENSHAW BLVD STE 215L
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1227
Practice Address - Country:US
Practice Address - Phone:323-291-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician