Provider Demographics
NPI:1124856166
Name:CAMPO PERALTA, ANA MARIA
Entity type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:
Last Name:CAMPO PERALTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 39TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2212
Mailing Address - Country:US
Mailing Address - Phone:510-412-5930
Mailing Address - Fax:510-412-0567
Practice Address - Street 1:205 39TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805
Practice Address - Country:US
Practice Address - Phone:510-412-5930
Practice Address - Fax:510-412-0567
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program