Healthcare Provider Details

I. General information

NPI: 1730601311
Provider Name (Legal Business Name): MR. RICARDO OCHOA MATA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 SANTA TERESA BLVD STE 104
SAN JOSE CA
95123-6515
US

IV. Provider business mailing address

705 NIDO DR APT 2
CAMPBELL CA
95008-4815
US

V. Phone/Fax

Practice location:
  • Phone: 408-225-9291
  • Fax:
Mailing address:
  • Phone: 831-737-6125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: