Healthcare Provider Details

I. General information

NPI: 1447101860
Provider Name (Legal Business Name): JUANA YERALDI CAMPOS DE. AVILA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6529 RIVERSIDE AVE STE 155
RIVERSIDE CA
92506-3118
US

IV. Provider business mailing address

6529 RIVERSIDE AVE STE 155
RIVERSIDE CA
92506-3118
US

V. Phone/Fax

Practice location:
  • Phone: 760-221-5104
  • Fax:
Mailing address:
  • Phone: 760-221-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: