Healthcare Provider Details

I. General information

NPI: 1093683153
Provider Name (Legal Business Name): BRYAN OCAMPO DELA CRUZ BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10819 EL CAMINO RD
LAS VEGAS NV
89141-8773
US

IV. Provider business mailing address

10819 EL CAMINO RD
LAS VEGAS NV
89141-8773
US

V. Phone/Fax

Practice location:
  • Phone: 661-229-9518
  • Fax:
Mailing address:
  • Phone: 702-463-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number845127
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: