Basic Information
| Provider Information | |||||||||
| NPI: | 1063856805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OCAMPO | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4290 POLK AVENUE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921051524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195630507 | ||||||||
| FaxNumber: | 6195630015 | ||||||||
| Practice Location | |||||||||
| Address1: | 4290 POLK AVENUE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921051524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195630507 | ||||||||
| FaxNumber: | 6195630015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 713306 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 95003427 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.