Basic Information
| Provider Information | |||||||||
| NPI: | 1225615024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPOS | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | CATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 7TH AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950624669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314761747 | ||||||||
| FaxNumber: | 8314761125 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 7TH AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950624669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314239015 | ||||||||
| FaxNumber: | 8314624970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2021 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | RH0006560321 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 215357 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.