Provider Demographics
NPI:1609441716
Name:CAMPOS MAGANA, CHRISTIAN ANTONIO
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ANTONIO
Last Name:CAMPOS MAGANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 INLAND EMPIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4802
Mailing Address - Country:US
Mailing Address - Phone:909-483-5000
Mailing Address - Fax:
Practice Address - Street 1:21 RANCHO CAMINO DR STE 106
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7020
Practice Address - Country:US
Practice Address - Phone:855-223-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician