MEDICARE: TRACY N OCAMPO FNP-C

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	363LF0000X	Family Nurse Practitioner	95005328	CA

General Provider Information

NPI Number	:	1649704115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY N OCAMPO FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 3699
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92659-8699
Country	:	US
Telephone Number	:	657-241-3600
Fax Number	:	657-241-7708

Provider Business Practice Location Address
First Line	:	13612 PHILADELPHIA ST
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4419
Country	:	US
Telephone Number	:	562-464-4548
Fax Number	:

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	07/16/2020

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