Healthcare Provider Details

I. General information

NPI: 1992453740
Provider Name (Legal Business Name): JORGE ELIECER SARA OCHOA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 STATE ROAD 60 W
LAKE WALES FL
33853-4419
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 863-949-4868
  • Fax: 863-223-8549
Mailing address:
  • Phone: 407-845-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1564
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023434
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: