Healthcare Provider Details

I. General information

NPI: 1407235781
Provider Name (Legal Business Name): EVELIO OCAMPO TRUEBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1566 SW 1ST ST
MIAMI FL
33135-2103
US

IV. Provider business mailing address

6100 BLUE LAGOON DR SUITE 400
MIAMI FL
33126-2079
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-8325
  • Fax:
Mailing address:
  • Phone: 305-398-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: