Provider Demographics
NPI:1265782528
Name:OCAMPO, MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:OCAMPO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3650 SOUTH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1532
Mailing Address - Country:US
Mailing Address - Phone:562-925-7401
Mailing Address - Fax:310-554-4045
Practice Address - Street 1:3650 SOUTH ST STE 106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1532
Practice Address - Country:US
Practice Address - Phone:562-925-7401
Practice Address - Fax:310-554-4045
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant