Provider Demographics
NPI:1235323007
Name:GRANDE, ELMER JASON OCAMPO (MD)
Entity type:Individual
Prefix:
First Name:ELMER JASON
Middle Name:OCAMPO
Last Name:GRANDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20101 LAKE CHABOT RD FL 3
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5305
Mailing Address - Country:US
Mailing Address - Phone:510-886-3400
Mailing Address - Fax:814-456-2375
Practice Address - Street 1:20101 LAKE CHABOT RD FL 3
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5305
Practice Address - Country:US
Practice Address - Phone:510-886-3400
Practice Address - Fax:510-506-7772
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC139074207Q00000X
PAMD435167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391865Medicare Oscar/Certification