Healthcare Provider Details

I. General information

NPI: 1265076194
Provider Name (Legal Business Name): PAULINA LIZBETH OCHOA OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39210 STATE ST STE 220
FREMONT CA
94538-1456
US

IV. Provider business mailing address

959 GILCHRIST DR APT 4
SAN JOSE CA
95133-2525
US

V. Phone/Fax

Practice location:
  • Phone: 510-894-4135
  • Fax:
Mailing address:
  • Phone: 408-854-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number46-1305562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: