Provider Demographics
NPI:1609858182
Name:DE OCAMPO, EMILLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILLIE
Middle Name:
Last Name:DE OCAMPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-384-3966
Practice Address - Street 1:1510 FLORIDA AVE
Practice Address - Street 2:F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4437
Practice Address - Country:US
Practice Address - Phone:209-549-7090
Practice Address - Fax:209-549-7099
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73019208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A730190OtherBLUE SHIELD OF CA PIN
CA057811OtherBOARD CERTIFICATION #
CA00A730190Medicaid
CA00A730190Medicaid
CABD4990861OtherDEA CERT #
CA00A730191Medicare PIN