Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD1031 | ME |
Y | 222Z00000X | Podiatrist | POD1031 | ME |
NPI | 1003902149 |
---|---|
Provider Name | Peter Tioseco Ocampo |
First Address | Scarborough, ME 04074-6900 |
Second Address | Scarborough, ME 04074-6900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U72588 | (02) | ME |