Healthcare Provider Details

I. General information

NPI: 1568919587
Provider Name (Legal Business Name): JENNIFER OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 MAIN ST
ROSEVILLE CA
95678-2232
US

IV. Provider business mailing address

3345 COTTAGE WAY APT 79
SACRAMENTO CA
95825-1416
US

V. Phone/Fax

Practice location:
  • Phone: 916-774-6802
  • Fax: 916-774-2685
Mailing address:
  • Phone: 831-776-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: