Provider Demographics
NPI:1659806677
Name:OCAMPO, HECTOR MANUEL
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:MANUEL
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:FORT GARLAND
Mailing Address - State:CO
Mailing Address - Zip Code:81133-0068
Mailing Address - Country:US
Mailing Address - Phone:719-992-8599
Mailing Address - Fax:
Practice Address - Street 1:18045 CTY RD GG
Practice Address - Street 2:
Practice Address - City:FORT GARLAND
Practice Address - State:CO
Practice Address - Zip Code:81133
Practice Address - Country:US
Practice Address - Phone:719-992-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8692171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications