Provider Demographics
NPI:1194899377
Name:RENATO V. OCAMPO, JR., MD, PA
Entity type:Organization
Organization Name:RENATO V. OCAMPO, JR., MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:VALENCIA
Authorized Official - Last Name:OCAMPO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-477-9771
Mailing Address - Street 1:9970 CENTRAL PARK BLVD N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2231
Mailing Address - Country:US
Mailing Address - Phone:561-477-9771
Mailing Address - Fax:561-487-9499
Practice Address - Street 1:9970 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2231
Practice Address - Country:US
Practice Address - Phone:561-477-9771
Practice Address - Fax:561-487-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68682208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG11164Medicare UPIN
FL27590AMedicare ID - Type UnspecifiedMEDICARE ID