Healthcare Provider Details

I. General information

NPI: 1700218427
Provider Name (Legal Business Name): PAYAL PANDYA OCAMPO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAYAL D PANDYA

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11822 FLORAL DR
WHITTIER CA
90601-2900
US

IV. Provider business mailing address

9606 IVES ST
BELLFLOWER CA
90706-3666
US

V. Phone/Fax

Practice location:
  • Phone: 562-908-4355
  • Fax: 562-908-4363
Mailing address:
  • Phone: 847-744-0422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: