Provider Demographics
NPI:1780234559
Name:CAMPOS, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
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 1:45909 GOLD MINE DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-1289
Mailing Address - Country:US
Mailing Address - Phone:951-852-8115
Mailing Address - Fax:
Practice Address - Street 1:41800 ENTERPRISE CIR S STE A
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4831
Practice Address - Country:US
Practice Address - Phone:951-296-1600
Practice Address - Fax:951-296-1602
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8085237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist