Healthcare Provider Details

I. General information

NPI: 1750404190
Provider Name (Legal Business Name): BENJAMIN OCHOA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 ADAMS AVE
SAN DIEGO CA
92116-2212
US

IV. Provider business mailing address

17023 SIENNA RIDGE DR
SAN DIEGO CA
92127-2866
US

V. Phone/Fax

Practice location:
  • Phone: 619-563-0802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: