Healthcare Provider Details

I. General information

NPI: 1861212706
Provider Name (Legal Business Name): STEPHANIE OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E VISTA WAY STE 1
VISTA CA
92084-2755
US

IV. Provider business mailing address

3020 OCEANSIDE BLVD APT 112
OCEANSIDE CA
92054-4837
US

V. Phone/Fax

Practice location:
  • Phone: 408-621-3996
  • Fax:
Mailing address:
  • Phone: 408-621-3996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: