Healthcare Provider Details

I. General information

NPI: 1811334329
Provider Name (Legal Business Name): ALICE OCAMPO BERMUNDO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 W PASADENA AVE
MOUNTAIN HOUSE CA
95391-1206
US

IV. Provider business mailing address

PO BOX 60206
SUNNYVALE CA
94088-0206
US

V. Phone/Fax

Practice location:
  • Phone: 408-480-8827
  • Fax:
Mailing address:
  • Phone: 408-480-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number677805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: