Healthcare Provider Details

I. General information

NPI: 1750094124
Provider Name (Legal Business Name): LISA LISET OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 12/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27141 HIDAWAY AVE STE 106
CANYON COUNTRY CA
91351-4135
US

IV. Provider business mailing address

13212 TOWNE AVE
LOS ANGELES CA
90061-2221
US

V. Phone/Fax

Practice location:
  • Phone: 661-252-8469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: