Healthcare Provider Details

I. General information

NPI: 1699454330
Provider Name (Legal Business Name): BRIDGET OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12669 ENCINITAS AVE
SYLMAR CA
91342-3635
US

IV. Provider business mailing address

21606 DEVONSHIRE ST # 3034
CHATSWORTH CA
91311-2901
US

V. Phone/Fax

Practice location:
  • Phone: 800-700-8705
  • Fax:
Mailing address:
  • Phone: 323-674-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number132262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: