Provider Demographics
NPI:1265969976
Name:CAMPOS ROGERS, ERICA (CATC 197173 I)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:CAMPOS ROGERS
Suffix:
Gender:F
Credentials:CATC 197173 I
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CATC-1 1971731
Mailing Address - Street 1:1462 S HIGHLAND AVE APT D107
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-3504
Mailing Address - Country:US
Mailing Address - Phone:213-270-4631
Mailing Address - Fax:
Practice Address - Street 1:4120 BIRCH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2219
Practice Address - Country:US
Practice Address - Phone:714-540-9070
Practice Address - Fax:714-884-4347
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197173I101YA0400X
CA197173101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)