Provider Demographics
NPI:1013545334
Name:CAMPA, LETTY GUADALUPE
Entity type:Individual
Prefix:
First Name:LETTY
Middle Name:GUADALUPE
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 1:1424 30TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3417
Mailing Address - Country:US
Mailing Address - Phone:619-565-2650
Mailing Address - Fax:
Practice Address - Street 1:1424 30TH ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3417
Practice Address - Country:US
Practice Address - Phone:619-565-2650
Practice Address - Fax:619-565-2656
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147337106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program