Provider Demographics
NPI:1376396812
Name:AMBROCIO CAMPOS, MARIA EUGENIA (PPS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EUGENIA
Last Name:AMBROCIO CAMPOS
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:EUGENIA
Other - Middle Name:
Other - Last Name:AMBROCIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PPS
Mailing Address - Street 1:402 FARNEL RD, STE M
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4960
Mailing Address - Country:US
Mailing Address - Phone:805-928-4736
Mailing Address - Fax:
Practice Address - Street 1:402 FARNEL RD STE M
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4960
Practice Address - Country:US
Practice Address - Phone:805-928-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210264757101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool