Healthcare Provider Details

I. General information

NPI: 1639319759
Provider Name (Legal Business Name): VICTOR DE OCAMPO LACHICA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S BELLVIEW
MESA AZ
85204-2504
US

IV. Provider business mailing address

1811 S ALMA SCHOOL RD STE 160
MESA AZ
85210-3001
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-7711
  • Fax:
Mailing address:
  • Phone: 480-831-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN134139
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: