Healthcare Provider Details

I. General information

NPI: 1699846865
Provider Name (Legal Business Name): JOSEPH DEOCAMPO PHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14120 BEACH BLVD SUITE # 104
WESTMINSTER CA
92683-4454
US

IV. Provider business mailing address

13729 MARQUITA LN
WHITTIER CA
90604-4374
US

V. Phone/Fax

Practice location:
  • Phone: 714-896-7367
  • Fax: 714-896-7316
Mailing address:
  • Phone: 714-896-7367
  • Fax: 714-896-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN491665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: