Provider Demographics
NPI:1487240859
Name:OCAMPO, FABRIENNE FRITZI LUCAS
Entity type:Individual
Prefix:
First Name:FABRIENNE FRITZI
Middle Name:LUCAS
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 1:301 E OKEEFE ST APT 15
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2119
Mailing Address - Country:US
Mailing Address - Phone:650-898-3424
Mailing Address - Fax:
Practice Address - Street 1:301 E OKEEFE ST APT 15
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2119
Practice Address - Country:US
Practice Address - Phone:650-898-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANAOtherNA