Healthcare Provider Details

I. General information

NPI: 1407172083
Provider Name (Legal Business Name): OLGA LUCIA OCHOA REINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLGA OCHOA M.D.

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 S PULASKI RD
CHICAGO IL
60629-4438
US

IV. Provider business mailing address

5635 S PULASKI RD
CHICAGO IL
60629-4438
US

V. Phone/Fax

Practice location:
  • Phone: 312-682-6110
  • Fax: 773-649-6331
Mailing address:
  • Phone: 312-682-6110
  • Fax: 773-649-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60274567
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036131818
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036131828
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number131818
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01077152A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: