Provider Demographics
NPI:1215644067
Name:CAMPOS, CORRINA DEBRA (NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:CORRINA
Middle Name:DEBRA
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6820
Mailing Address - Country:US
Mailing Address - Phone:626-602-4511
Mailing Address - Fax:
Practice Address - Street 1:1021 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6820
Practice Address - Country:US
Practice Address - Phone:626-602-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist