Basic Information
Provider Information
NPI: 1033557798
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OCAMPO
FirstName: SANDRA
MiddleName: CELIS
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CASTRO
OtherFirstName: SANDRA
OtherMiddleName: CELIS
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X7248-SNVY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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