Healthcare Provider Details

I. General information

NPI: 1396201109
Provider Name (Legal Business Name): ANGEL GERARDO OCHOA-REA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2019
Last Update Date: 02/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3069 LINCOLN AVE
SAN DIEGO CA
92104-3030
US

IV. Provider business mailing address

3069 LINCOLN AVE
SAN DIEGO CA
92104-3030
US

V. Phone/Fax

Practice location:
  • Phone: 619-300-3838
  • Fax:
Mailing address:
  • Phone: 619-300-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: