Healthcare Provider Details

I. General information

NPI: 1073015277
Provider Name (Legal Business Name): CAROLINA OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 DOWNEY AVE SPC 54
PARAMOUNT CA
90723-6535
US

IV. Provider business mailing address

16600 DOWNEY AVE SPC 54
PARAMOUNT CA
90723-6535
US

V. Phone/Fax

Practice location:
  • Phone: 562-884-9022
  • Fax:
Mailing address:
  • Phone: 562-884-9022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-27060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: