Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013476167 |
---|---|
Provider Name | Yvette Campos |
First Address | Long Beach, CA 90810-1876 |
Second Address | Long Beach, CA 90810-1876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2019 |
Last Update Date | 29/01/2020 |