MEDICARE: RITA ANNE CAMPBELL MFT

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	106H00000X	Marriage & Family Therapist	MFC27066	CA

General Provider Information

NPI Number	:	1780869131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA ANNE CAMPBELL MFT

Provider Business Mailing Address
First Line	:	973 VALE TERRACE
Second Line	:	#206
City	:	VISTA
State	:	CA
Zip	:	92084-5254
Country	:	US
Telephone Number	:	619-526-7110
Fax Number	:	760-753-5275

Provider Business Practice Location Address
First Line	:	973 VALE TERRACE
Second Line	:	#206
City	:	VISTA
State	:	CA
Zip	:	92084-5254
Country	:	US
Telephone Number	:	619-526-7110
Fax Number	:	760-753-5275

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/04/2008

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