Provider Demographics
NPI:1780278317
Name:CAMPOSAGRADO, KARINA ASHLEY (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:KARINA ASHLEY
Middle Name:
Last Name:CAMPOSAGRADO
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:
Other - Last Name:CAMPOSAGRADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3730 S SEPULVEDA BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6880
Mailing Address - Country:US
Mailing Address - Phone:916-882-1107
Mailing Address - Fax:
Practice Address - Street 1:3730 S SEPULVEDA BLVD APT 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6880
Practice Address - Country:US
Practice Address - Phone:916-882-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist