Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY18263 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY18263 | CA |
N | 103TC1900X | Counseling Psychologist | PSY18263 | CA |
NPI | 1073695649 |
---|---|
Provider Name | Dr. Alvaro Campos Jr |
First Address | Los Angeles, CA 90042-4883 |
Second Address | Los Angeles, CA 90031-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 02/03/2021 |