Provider Demographics
NPI:1134117021
Name:OCAMPO, MA STELLA (MD)
Entity Type:Individual
Prefix:
First Name:MA
Middle Name:STELLA
Last Name:OCAMPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1012 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2101
Mailing Address - Country:US
Mailing Address - Phone:719-383-5900
Mailing Address - Fax:719-383-6533
Practice Address - Street 1:128 MARKET ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2290
Practice Address - Country:US
Practice Address - Phone:719-589-5161
Practice Address - Fax:719-589-5722
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO39744208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
370020632OtherTRAVELERS MEDICARE
CO840706945109OtherROCKY MOUNTAIN HEALTH PLA
COOC654645OtherANTHEM BCBS
CO59236825Medicaid
COOC654645OtherANTHEM BCBS
CO59236825Medicaid