Healthcare Provider Details

I. General information

NPI: 1992052245
Provider Name (Legal Business Name): FABRICIO GERARDO OCHOA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9985 SIERRA AVE FL MOB
FONTANA CA
92335-6720
US

IV. Provider business mailing address

1878 OVERLAND ST
COLTON CA
92324-6304
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-0036
  • Fax:
Mailing address:
  • Phone: 562-706-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA127194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: