Provider Demographics
NPI:1619794674
Name:CAMPOS, JOSEPH MATTHEW JR
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:CAMPOS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1370 KAIHUOPALAAI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3523
Mailing Address - Country:US
Mailing Address - Phone:915-996-7915
Mailing Address - Fax:
Practice Address - Street 1:420 WAIAKAMILO RD STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4950
Practice Address - Country:US
Practice Address - Phone:808-393-9826
Practice Address - Fax:808-442-4582
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician