Healthcare Provider Details

I. General information

NPI: 1558489807
Provider Name (Legal Business Name): AGNES OCAMPO BILOG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E SHEA BLVD SUITE 100
SCOTTSDALE AZ
85254-4603
US

IV. Provider business mailing address

5020 E SHEA BLVD SUITE 100
SCOTTSDALE AZ
85254-4603
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-0050
  • Fax: 480-443-4018
Mailing address:
  • Phone: 480-443-0050
  • Fax: 480-443-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number31558
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: