Provider Demographics
NPI:1699018002
Name:CAMPOS, JOAQUIN ALEJANDRO
Entity type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:ALEJANDRO
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19700 S VERMONT AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1100
Mailing Address - Country:US
Mailing Address - Phone:213-252-5800
Mailing Address - Fax:310-329-3611
Practice Address - Street 1:19700 S VERMONT AVE
Practice Address - Street 2:STE 250
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1100
Practice Address - Country:US
Practice Address - Phone:213-252-5800
Practice Address - Fax:310-329-3611
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health