Healthcare Provider Details

I. General information

NPI: 1710894050
Provider Name (Legal Business Name): CARISSA ELENI ARTEAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARISSA ELENI CAMPA

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 STANISLAUS AVE
ANGELS CAMP CA
95222-9114
US

IV. Provider business mailing address

7683 ADOBE GULCH RD
SHEEP RANCH CA
95246-9439
US

V. Phone/Fax

Practice location:
  • Phone: 209-419-2793
  • Fax:
Mailing address:
  • Phone: 209-419-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: