MEDICARE: CRISTINA JOSE-KAMPFNER

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	103T00000X	Psychologist	RPS-2007107	CA

General Provider Information

NPI Number	:	1902065212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA JOSE-KAMPFNER

Provider Business Mailing Address
First Line	:	7849 E VIEWRIM DR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808-2131
Country	:	US
Telephone Number	:	323-307-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 S INDIANA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-3911
Country	:	US
Telephone Number	:	323-307-0160
Fax Number	:

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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