Healthcare Provider Details

I. General information

NPI: 1750107066
Provider Name (Legal Business Name): MARIA DE JESUS OCHOA MURILLO RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2066
US

IV. Provider business mailing address

1946 19TH ST
SAN PABLO CA
94806-3526
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-6546
  • Fax: 510-204-6005
Mailing address:
  • Phone: 510-407-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN95233465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: