Healthcare Provider Details

I. General information

NPI: 1679408934
Provider Name (Legal Business Name): REYNA MICHELLE OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 ARDILLA AVE
ATASCADERO CA
93422-3222
US

IV. Provider business mailing address

3111 PINE ST APT 200
PASO ROBLES CA
93446-1372
US

V. Phone/Fax

Practice location:
  • Phone: 805-464-4660
  • Fax:
Mailing address:
  • Phone: 805-464-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: