Provider Demographics
NPI:1629826490
Name:CAMPODONICO, SABRINA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:CAMPODONICO
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 1:4626 HARTLEY ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4747
Mailing Address - Country:US
Mailing Address - Phone:786-597-4929
Mailing Address - Fax:
Practice Address - Street 1:4626 HARTLEY ST APT 11
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4747
Practice Address - Country:US
Practice Address - Phone:786-597-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health