Provider Demographics
NPI:1982946224
Name:CAMPOS, AMARANTA AMATISTA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMARANTA
Middle Name:AMATISTA
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 S NOGALES HWY UNIT 6
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-9207
Mailing Address - Country:US
Mailing Address - Phone:520-906-3459
Mailing Address - Fax:
Practice Address - Street 1:15920 S RANCHO SAHUARITA BLVD STE 160
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8014
Practice Address - Country:US
Practice Address - Phone:520-867-8064
Practice Address - Fax:520-867-8063
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-15113247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other