MEDICARE: MRS. ESTEFANIA L OCAMPO

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	311ZA0620X	Adult Care Home Facility	0016594	WI

General Provider Information

NPI Number	:	1912517475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ESTEFANIA L OCAMPO

Provider Business Mailing Address
First Line	:	1318 NORTH ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3375
Country	:	US
Telephone Number	:	262-210-4003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 S UNION ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2646
Country	:	US
Telephone Number	:	414-249-3547
Fax Number	:	414-249-3957

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

Provider Enumeration Date	:	08/08/2020
Last Update Date	:	08/08/2020

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