Healthcare Provider Details

I. General information

NPI: 1376295352
Provider Name (Legal Business Name): DAISY OCAMPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 S CICERO AVE
CICERO IL
60804-2544
US

IV. Provider business mailing address

2016 N SAWYER AVE
CHICAGO IL
60647-3708
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-9500
  • Fax:
Mailing address:
  • Phone: 773-697-1521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: