MEDICARE: KATHERIN MARIE GUEVARA OCAMPO RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033818323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERIN MARIE GUEVARA OCAMPO RD

Provider Business Mailing Address
First Line	:	5531 BLOSSOM GARDENS CIR # 5531
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-6163
Country	:	US
Telephone Number	:	510-375-7545
Fax Number	:

Provider Business Practice Location Address
First Line	:	5531 BLOSSOM GARDENS CIR # 5531
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-6163
Country	:	US
Telephone Number	:	510-375-7545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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