Provider Demographics
NPI:1194899427
Name:OCAMPO, RENATO VALENCIA JR (MD)
Entity type:Individual
Prefix:
First Name:RENATO
Middle Name:VALENCIA
Last Name:OCAMPO
Suffix:JR
Gender:M
Credentials:MD
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Other - Middle Name:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME68682208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27590AMedicare ID - Type UnspecifiedMEDICARE PART B ID
FLG11164Medicare UPIN