Provider Demographics
NPI:1386882967
Name:OCAMPO, JOANTONETTE ROA (NP)
Entity type:Individual
Prefix:
First Name:JOANTONETTE
Middle Name:ROA
Last Name:OCAMPO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ARROYO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1545
Mailing Address - Country:US
Mailing Address - Phone:818-336-3107
Mailing Address - Fax:818-336-3108
Practice Address - Street 1:1200 ARROYO ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1545
Practice Address - Country:US
Practice Address - Phone:818-336-3107
Practice Address - Fax:818-336-3108
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA622056163W00000X
CA18420363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse