Healthcare Provider Details

I. General information

NPI: 1376154328
Provider Name (Legal Business Name): CHLOE NICOLE OCHOA CAMACHO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 E RIDGECREST BLVD
RIDGECREST CA
93555-4368
US

IV. Provider business mailing address

935 E RIDGECREST BLVD
RIDGECREST CA
93555-4368
US

V. Phone/Fax

Practice location:
  • Phone: 760-371-1411
  • Fax: 760-371-1410
Mailing address:
  • Phone: 760-371-1411
  • Fax: 760-371-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306908
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-06625
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1331849
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: