Healthcare Provider Details

I. General information

NPI: 1437495173
Provider Name (Legal Business Name): GINA GUARING OCAMPO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 S MAIN ST SUITE 100
CORONA CA
92882-3408
US

IV. Provider business mailing address

19202 AMALFI COURT
WALNUT CA
91789-4204
US

V. Phone/Fax

Practice location:
  • Phone: 951-270-0067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: