Provider Demographics
NPI:1801055256
Name:OCAMPO-WONG, MYLA OQUENDO (RD)
Entity type:Individual
Prefix:MS
First Name:MYLA
Middle Name:OQUENDO
Last Name:OCAMPO-WONG
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39500 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2211
Mailing Address - Country:US
Mailing Address - Phone:510-770-8040
Mailing Address - Fax:510-770-8141
Practice Address - Street 1:22331 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3911
Practice Address - Country:US
Practice Address - Phone:510-471-5880
Practice Address - Fax:510-609-0816
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA956552133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered