Basic Information
| Provider Information | |||||||||
| NPI: | 1083933527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPOS | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 138 S L ST | ||||||||
| Address2: | |||||||||
| City: | DINUBA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936182323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595960200 | ||||||||
| FaxNumber: | 5595960500 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 S L ST | ||||||||
| Address2: | |||||||||
| City: | DINUBA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936182323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595960200 | ||||||||
| FaxNumber: | 5595960500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2010 | ||||||||
| LastUpdateDate: | 05/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | 32394 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.