Provider Demographics
NPI:1790065134
Name:OCAMPO, PASCUALA GERALDINE TIEMSEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PASCUALA GERALDINE
Middle Name:TIEMSEN
Last Name:OCAMPO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401-A WATERMAN BLVD SUITE 8
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2632
Mailing Address - Country:US
Mailing Address - Phone:209-834-7300
Mailing Address - Fax:
Practice Address - Street 1:2401A WATERMAN BLVD STE 8
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1800
Practice Address - Country:US
Practice Address - Phone:209-834-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice