Provider Demographics
NPI:1841756608
Name:CAMPOS, SILVIA RUBY
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:RUBY
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 1:650 DUVALL AVE NE APT H832
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5762
Mailing Address - Country:US
Mailing Address - Phone:213-321-0511
Mailing Address - Fax:
Practice Address - Street 1:651 STANDER BLVD.
Practice Address - Street 2:SUITE 112
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:206-313-8840
Practice Address - Fax:206-641-9540
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician