MEDICARE: DR. DAVID BRENT OCEPEK M.D.

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	208000000X	Pediatrics Physician	G30755	CA
2	208000000X	Pediatrics Physician	13259	AZ

General Provider Information

NPI Number	:	1154497360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BRENT OCEPEK M.D.

Provider Business Mailing Address
First Line	:	1517 FOREST KNOLL DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-1333
Country	:	US
Telephone Number	:	310-890-7270
Fax Number	:	310-659-1084

Provider Business Practice Location Address
First Line	:	1517 FOREST KNOLL DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-1333
Country	:	US
Telephone Number	:	310-890-7270
Fax Number	:	310-659-1084

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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