Basic Information
| Provider Information | |||||||||
| NPI: | 1033557798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OCAMPO | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | CELIS | ||||||||
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| OtherLastName: | CASTRO | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | CELIS | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 148 SITKA SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890157487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023712523 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8685 S EASTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891232839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027540807 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 07/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7248-S | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.