MEDICARE: OCHOA MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	HCC7105	FL

General Provider Information

NPI Number	:	1598786014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCHOA MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	11300 NW 87TH CT
Second Line	:	SUITE 161
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4586
Country	:	US
Telephone Number	:	305-231-1360
Fax Number	:	305-231-1362

Provider Business Practice Location Address
First Line	:	11300 NW 87TH CT
Second Line	:	SUITE 161
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4586
Country	:	US
Telephone Number	:	305-231-1360
Fax Number	:	305-231-1362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OMAR OCHOA
Credential	:
Telephone Number	:	305-231-1360

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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