Provider Demographics
NPI:1952408981
Name:OCAMPO, CONSUELO M (MD)
Entity Type:Individual
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First Name:CONSUELO
Middle Name:M
Last Name:OCAMPO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE 138
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:951-695-7228
Mailing Address - Fax:951-695-7023
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD
Practice Address - Street 2:STE 138
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-695-7228
Practice Address - Fax:951-695-7023
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA52309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A523091Medicaid
CA00A523090Medicare ID - Type Unspecified
CA00A523091Medicaid