Provider Demographics
NPI:1124233283
Name:CAMPOS, TANIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7999
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7999
Mailing Address - Country:US
Mailing Address - Phone:787-565-9119
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3531
Practice Address - Country:US
Practice Address - Phone:787-992-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical