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General NPI Number Information
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NPI Number | 1568240968
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Entity Type | Individual
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Provider Name | COURTNEY AMELIA CAMPUZANO
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Gender | Female
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1600 WEEOT WAY
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City | ARCATA
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State | CA
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Zip | 95521-4734
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Country | US
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Telephone | 707-825-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 2066 11TH ST
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City | ARCATA
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State | CA
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Zip | 95521-5478
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Country | US
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Telephone | 562-208-3064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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