Healthcare Provider Details

I. General information

NPI: 1063711067
Provider Name (Legal Business Name): KELLY MARIE OCHOA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MARIE MACKIN M.D.

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 09/21/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWN CENTER DR STE 300
OXNARD CA
93036-1117
US

IV. Provider business mailing address

1000 TOWN CENTER DR STE 300
OXNARD CA
93036-1117
US

V. Phone/Fax

Practice location:
  • Phone: 559-797-1686
  • Fax:
Mailing address:
  • Phone: 559-797-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA115696
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberA115696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: