Healthcare Provider Details

I. General information

NPI: 1528955507
Provider Name (Legal Business Name): ETHAN OCHOA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W WARNER AVE
SANTA ANA CA
92707-3147
US

IV. Provider business mailing address

12352 ELMWOOD ST
GARDEN GROVE CA
92840-3472
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-6450
  • Fax:
Mailing address:
  • Phone: 310-729-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: