Healthcare Provider Details

I. General information

NPI: 1336426469
Provider Name (Legal Business Name): JORGE LUIS OCHOA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW 113 AVE # 202
MIAMI FL
33174-1169
US

IV. Provider business mailing address

200 SW 113 AVE # 202
MIAMI FL
33174-1169
US

V. Phone/Fax

Practice location:
  • Phone: 305-508-8847
  • Fax:
Mailing address:
  • Phone: 305-508-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberMA 63281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: