Provider Demographics
NPI:1033818323
Name:GUEVARA OCAMPO, KATHERIN MARIE (RD)
Entity Type:Individual
Prefix:
First Name:KATHERIN
Middle Name:MARIE
Last Name:GUEVARA OCAMPO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 BLOSSOM GARDENS CIR # 5531
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-6163
Mailing Address - Country:US
Mailing Address - Phone:510-375-7545
Mailing Address - Fax:
Practice Address - Street 1:5531 BLOSSOM GARDENS CIR # 5531
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6163
Practice Address - Country:US
Practice Address - Phone:510-375-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA111Medicaid