Basic Information
| Provider Information | |||||||||
| NPI: | 1326301342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPOS | ||||||||
| FirstName: | JULIO | ||||||||
| MiddleName: | CESAR | ||||||||
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| Credential: | AMFT121712 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 E 4TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148248140 | ||||||||
| FaxNumber: | 7148248142 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 E 4TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148248140 | ||||||||
| FaxNumber: | 7148248142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT121712 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.