Provider Demographics
NPI:1518281450
Name:CONSUELO TERESA M. OCAMPO, M.D. INC.
Entity Type:Organization
Organization Name:CONSUELO TERESA M. OCAMPO, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSUELO TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OCAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-695-7228
Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD.
Mailing Address - Street 2:SUITE 138
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:951-695-7228
Mailing Address - Fax:951-695-7023
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD.
Practice Address - Street 2:SUITE 138
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-695-7228
Practice Address - Fax:951-695-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A523091Medicaid
CA00A523090Medicare PIN
CA00A523091Medicaid