Healthcare Provider Details

I. General information

NPI: 1568240968
Provider Name (Legal Business Name): COURTNEY AMELIA CAMPUZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

IV. Provider business mailing address

2066 11TH ST
ARCATA CA
95521-5478
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-5060
  • Fax:
Mailing address:
  • Phone: 562-208-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: