Provider Demographics
NPI:1104693274
Name:OCAMPO, JASMINE ANGEL
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ANGEL
Last Name:OCAMPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9377 HAVEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5340
Mailing Address - Country:US
Mailing Address - Phone:909-906-1505
Mailing Address - Fax:909-906-1508
Practice Address - Street 1:9377 HAVEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5340
Practice Address - Country:US
Practice Address - Phone:909-909-1505
Practice Address - Fax:909-906-1508
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health