Individual
MS. NICHOLE MONIC CAMPOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
1020 S ARROYO PKWY, PASADENA, CA 91105-3911
(626) 254-5000
Mailing address
300 N SHADYGLEN DR, COVINA, CA 91724-2911
(626) 498-5250
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 37808
CA
Other
Enumeration date
10/20/2014
Last updated
10/20/2014
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