MEDICARE: HENRY CAMPA JR.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1790806313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY CAMPA JR.

Provider Business Mailing Address
First Line	:	PO BOX 730276
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95173-0276
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 BALDWIN ST
Second Line	:	SUITE A
City	:	SALINAS
State	:	CA
Zip	:	93906-3681
Country	:	US
Telephone Number	:	831-449-7974
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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