Healthcare Provider Details

I. General information

NPI: 1215133269
Provider Name (Legal Business Name): LUCIA A OCHOA ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCIA A GUTIERREZ ASW

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E 6TH ST
MADERA CA
93638-3631
US

IV. Provider business mailing address

344 E 6TH ST
MADERA CA
93638-3631
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone: 559-664-4000
  • Fax: 559-675-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: