Healthcare Provider Details

I. General information

NPI: 1427877968
Provider Name (Legal Business Name): JOEL OCHOA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W CULLERTON ST APT 2C
CHICAGO IL
60608-3480
US

IV. Provider business mailing address

1440 W TAYLOR ST APT 2C
CHICAGO IL
60607-4623
US

V. Phone/Fax

Practice location:
  • Phone: 312-450-1238
  • Fax: 815-264-5190
Mailing address:
  • Phone: 312-450-1238
  • Fax: 815-264-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: