Healthcare Provider Details

I. General information

NPI: 1215424254
Provider Name (Legal Business Name): JONATHAN KEVIN OCHOA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JOHN MUIR PKWY STE 100
BRENTWOOD CA
94513-5184
US

IV. Provider business mailing address

PO BOX 31396
WALNUT CREEK CA
94598-8396
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-8585
  • Fax:
Mailing address:
  • Phone: 925-939-8585
  • Fax: 925-933-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA164705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: