Provider Demographics
NPI:1083350458
Name:DE OCAMPO, RICARDO PEJER (NP)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:PEJER
Last Name:DE OCAMPO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2842
Mailing Address - Country:US
Mailing Address - Phone:323-770-3123
Mailing Address - Fax:
Practice Address - Street 1:6363 WILSHIRE BLVD STE 516
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5726
Practice Address - Country:US
Practice Address - Phone:310-933-4590
Practice Address - Fax:310-526-3452
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950191591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily