Healthcare Provider Details

I. General information

NPI: 1518843259
Provider Name (Legal Business Name): MATTHEW SPENCER NATIVIDAD OCAMPO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST STE 1000
LOS ANGELES CA
90033-5312
US

IV. Provider business mailing address

200 MESNAGERS ST APT 643
LOS ANGELES CA
90012-0018
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-0500
  • Fax:
Mailing address:
  • Phone: 650-892-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number90522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: