Basic Information
| Provider Information | |||||||||
| NPI: | 1477162428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ OCAMPO | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | HERNANDEZ | ||||||||
| OtherFirstName: | RICARDO | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7135 WILBUR AVE APT 306 | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913353963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189838465 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20151 NORDHOFF ST | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913116215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184073200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2020 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.