Provider Demographics
NPI:1639652258
Name:CAMPOS, YESSICA ARELY
Entity Type:Individual
Prefix:
First Name:YESSICA
Middle Name:ARELY
Last Name:CAMPOS
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 1:50 S ANAHEIM BLVD STE 241
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2961
Mailing Address - Country:US
Mailing Address - Phone:714-785-2530
Mailing Address - Fax:
Practice Address - Street 1:50 S ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2931
Practice Address - Country:US
Practice Address - Phone:714-785-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator