Provider Demographics
NPI:1306997267
Name:OCAMPO, RODOLFO BAYLE (CRNA)
Entity type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:BAYLE
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 REDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9581
Mailing Address - Country:US
Mailing Address - Phone:301-934-8738
Mailing Address - Fax:
Practice Address - Street 1:701 E CHARLES ST
Practice Address - Street 2:CIVISTA MEDICAL CENTER
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9581
Practice Address - Country:US
Practice Address - Phone:301-609-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR064594367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430051194OtherMEDICARE RAILROAD
MD699300100Medicaid
MD702L73DDMedicare PIN