Healthcare Provider Details

I. General information

NPI: 1205767142
Provider Name (Legal Business Name): NYDIA OCHOA BRAVO PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 ISIS AVE
HAWTHORNE CA
90250-4149
US

IV. Provider business mailing address

12501 ISIS AVE
HAWTHORNE CA
90250-4149
US

V. Phone/Fax

Practice location:
  • Phone: 310-725-5800
  • Fax:
Mailing address:
  • Phone: 310-725-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: