Healthcare Provider Details

I. General information

NPI: 1346892262
Provider Name (Legal Business Name): CINDY MADDUX OCHOA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8804 BALBOA AVE
SAN DIEGO CA
92123-1506
US

IV. Provider business mailing address

8804 BALBOA AVE
SAN DIEGO CA
92123-1506
US

V. Phone/Fax

Practice location:
  • Phone: 858-637-3334
  • Fax:
Mailing address:
  • Phone: 858-637-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: