Healthcare Provider Details

I. General information

NPI: 1770924730
Provider Name (Legal Business Name): GLORIA AMPARO OCHOA-ANDIA RD, CDE, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLORIA OCHOA-ANDIA

II. Dates (important events)

Enumeration Date: 07/07/2013
Last Update Date: 08/07/2021
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 ROSA DR
LAWRENCEVILLE GA
30044-6613
US

IV. Provider business mailing address

761 ROSA DR
LAWRENCEVILLE GA
30044-6613
US

V. Phone/Fax

Practice location:
  • Phone: 678-680-3261
  • Fax: 833-441-1804
Mailing address:
  • Phone: 678-680-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003098
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: