Provider Demographics
NPI:1457912776
Name:CAMPOS, EMELY CELESTE
Entity Type:Individual
Prefix:
First Name:EMELY
Middle Name:CELESTE
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 1:4044 HORNBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-2829
Mailing Address - Country:US
Mailing Address - Phone:626-435-7772
Mailing Address - Fax:
Practice Address - Street 1:4044 HORNBROOK AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-2829
Practice Address - Country:US
Practice Address - Phone:626-435-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician