Healthcare Provider Details

I. General information

NPI: 1720560352
Provider Name (Legal Business Name): EMMA JOHANA OCAMPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD STE 210
LOS ANGELES CA
90017-1931
US

IV. Provider business mailing address

1200 WILSHIRE BLVD STE 200
LOS ANGELES CA
90017-1930
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7444
  • Fax:
Mailing address:
  • Phone: 213-481-7464
  • Fax: 213-481-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: