Provider Demographics
NPI:1295781193
Name:DEOCAMPO, ANNA C (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:C
Last Name:DEOCAMPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA CHRISTINA
Other - Middle Name:CATINDIG
Other - Last Name:DE OCAMPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5020 E SHEA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4603
Mailing Address - Country:US
Mailing Address - Phone:480-443-0050
Mailing Address - Fax:480-443-4018
Practice Address - Street 1:5020 E SHEA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4603
Practice Address - Country:US
Practice Address - Phone:480-443-0050
Practice Address - Fax:480-443-4018
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ356042080P0006X
SC20906208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC209063Medicaid
SC57-6007863037OtherBLUE CHOICE OF SC
SC7481470OtherCIGNA
SC57-6007863094OtherBCBS OF SC
SCH35042Medicare UPIN
SC209063Medicaid