Healthcare Provider Details

I. General information

NPI: 1194899427
Provider Name (Legal Business Name): RENATO VALENCIA OCAMPO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD N SUITE 204
BOCA RATON FL
33428-2231
US

IV. Provider business mailing address

9970 CENTRAL PARK BLVD N SUITE 204
BOCA RATON FL
33428-2231
US

V. Phone/Fax

Practice location:
  • Phone: 561-477-9771
  • Fax: 561-487-9499
Mailing address:
  • Phone: 561-477-9771
  • Fax: 561-487-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME68682
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: