MEDICARE: REYNALDO OCAMPO GOMEZ 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	174400000X	Specialist	A51395	CA

General Provider Information

NPI Number	:	1386647394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNALDO OCAMPO GOMEZ M.D.

Provider Business Mailing Address
First Line	:	74998 COUNTRY CLUB DR
Second Line	:	SUITE 220, PMB 183
City	:	PALM DESERT
State	:	CA
Zip	:	92260-1970
Country	:	US
Telephone Number	:	760-416-3770
Fax Number	:	760-320-8551

Provider Business Practice Location Address
First Line	:	1180 N INDIAN CANYON DR
Second Line	:	STE W300
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4809
Country	:	US
Telephone Number	:	760-416-3770
Fax Number	:	760-320-8551

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/07/2013

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