Healthcare Provider Details

I. General information

NPI: 1538665658
Provider Name (Legal Business Name): EVELYN OCHOA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

3201 S MARYLAND PKWY STE 608
LAS VEGAS NV
89109-2428
US

V. Phone/Fax

Practice location:
  • Phone: 602-546-2923
  • Fax:
Mailing address:
  • Phone: 702-580-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22551
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: