Healthcare Provider Details

I. General information

NPI: 1376674770
Provider Name (Legal Business Name): MARIO A. OCHOA M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 MCCALL AVE SUITE 102
SELMA CA
93662-2505
US

IV. Provider business mailing address

3275 MCCALL AVE SUITE 102
SELMA CA
93662-2505
US

V. Phone/Fax

Practice location:
  • Phone: 559-896-3808
  • Fax: 559-896-3875
Mailing address:
  • Phone: 559-896-3808
  • Fax: 559-896-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76417
License Number StateCA

VIII. Authorized Official

Name: MARIO OCHOA
Title or Position: OWNER
Credential: M.D.
Phone: 559-896-3808