Provider Demographics
NPI:1154497360
Name:OCEPEK, DAVID BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRENT
Last Name:OCEPEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1517 FOREST KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-1333
Mailing Address - Country:US
Mailing Address - Phone:310-890-7270
Mailing Address - Fax:310-659-1084
Practice Address - Street 1:1517 FOREST KNOLL DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-1333
Practice Address - Country:US
Practice Address - Phone:310-890-7270
Practice Address - Fax:310-659-1084
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30755208000000X
AZ13259208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D37391Medicare UPIN