Provider Demographics
NPI:1104645753
Name:CAMPOS, CHRISTIAN DAVID
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DAVID
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:14508 LOCH NEVIS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-5145
Mailing Address - Country:US
Mailing Address - Phone:562-484-4751
Mailing Address - Fax:
Practice Address - Street 1:14508 LOCH NEVIS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-5145
Practice Address - Country:US
Practice Address - Phone:562-484-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist