1801070016 NPI number — MRS. LETICIA ARELY CAMPOS LMSW

Table of content: MRS. LETICIA ARELY CAMPOS LMSW (NPI 1801070016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801070016 NPI number — MRS. LETICIA ARELY CAMPOS LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPOS
Provider First Name:
LETICIA
Provider Middle Name:
ARELY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERLA-CAMPOS
Provider Other First Name:
LETICIA
Provider Other Middle Name:
ARELY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1801070016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 761884
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78245-6884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-764-5540
Provider Business Mailing Address Fax Number:
210-764-5541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 FERDINAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78245-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-764-5540
Provider Business Practice Location Address Fax Number:
210-764-5541
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  38386 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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