Healthcare Provider Details

I. General information

NPI: 1154497360
Provider Name (Legal Business Name): DAVID BRENT OCEPEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 FOREST KNOLL DR
LOS ANGELES CA
90069-1333
US

IV. Provider business mailing address

1517 FOREST KNOLL DR
LOS ANGELES CA
90069-1333
US

V. Phone/Fax

Practice location:
  • Phone: 310-890-7270
  • Fax: 310-659-1084
Mailing address:
  • Phone: 310-890-7270
  • Fax: 310-659-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG30755
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13259
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: