Individual provider Active NPI

Alvaro Campos Jr, PHD

  • Clinical Psychologist
  • Los Angeles, CA
National Provider Identifier
1073695649
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY18263 Issued in CA
Practice address
3303 N Broadway
Los Angeles, CA 90031-2803
Phone
(323) 478-8200
Fax
(323) 221-2036
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X PSY18263 CA
Clinical Psychologist 103TC0700X PSY18263 CA Primary

Addresses

Primary practice location

3303 N Broadway
Los Angeles, CA 90031-2803

Mailing address

5321 Via Marisol
Los Angeles, CA 90042-4883
Phone (323) 478-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
18263CAMDUrology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1073695649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5321 VIA MARISOL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900424883",
            "telephone_number": "323-478-8200",
            "fax_number": "323-344-8829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 N BROADWAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900312803",
            "telephone_number": "323-478-8200",
            "fax_number": "323-221-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPOS JR",
        "first_name": "ALVARO",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY18263",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY18263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.