MEDICARE: DR. ALVARO CAMPOS JR PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PSY18263	CA
2	103TC0700X	Clinical Psychologist	PSY18263	CA

General Provider Information

NPI Number	:	1073695649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALVARO CAMPOS JR PHD

Provider Business Mailing Address
First Line	:	5321 VIA MARISOL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-4883
Country	:	US
Telephone Number	:	323-478-8200
Fax Number	:	323-344-8829

Provider Business Practice Location Address
First Line	:	3303 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2803
Country	:	US
Telephone Number	:	323-478-8200
Fax Number	:	323-221-2036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/02/2021

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