Healthcare Provider Details

I. General information

NPI: 1255970240
Provider Name (Legal Business Name): DEANNA OCAMPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15478 VENTURA BLVD
SHERMAN OAKS CA
91403-3002
US

IV. Provider business mailing address

749 37TH AVE
SANTA CRUZ CA
95062-5124
US

V. Phone/Fax

Practice location:
  • Phone: 844-322-7483
  • Fax:
Mailing address:
  • Phone: 844-322-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: