Provider Demographics
NPI:1376918623
Name:CAMPA, ANNE MICHELLE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MICHELLE
Last Name:CAMPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3947 LENNANE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1971
Mailing Address - Country:US
Mailing Address - Phone:916-283-8280
Mailing Address - Fax:916-283-8259
Practice Address - Street 1:3947 LENNANE DR STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1971
Practice Address - Country:US
Practice Address - Phone:916-283-8280
Practice Address - Fax:916-283-8259
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3576OtherSUN STREET CENTERS