Healthcare Provider Details

I. General information

NPI: 1801055256
Provider Name (Legal Business Name): MYLA OQUENDO OCAMPO-WONG R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22331 MISSION BLVD
HAYWARD CA
94541-3911
US

IV. Provider business mailing address

39500 LIBERTY ST
FREMONT CA
94538-2211
US

V. Phone/Fax

Practice location:
  • Phone: 510-471-5880
  • Fax: 510-609-0816
Mailing address:
  • Phone: 510-770-8040
  • Fax: 510-770-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number956552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: