Provider Demographics
NPI:1275083180
Name:OCAMPO, NORMAN VINCENT (PT)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:VINCENT
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S GARDENIA ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4122
Mailing Address - Country:US
Mailing Address - Phone:714-348-5654
Mailing Address - Fax:
Practice Address - Street 1:237 S GARDENIA ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4122
Practice Address - Country:US
Practice Address - Phone:714-348-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist