Healthcare Provider Details

I. General information

NPI: 1396907606
Provider Name (Legal Business Name): VICTORIA A OCHOA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W WAVERLY ST
MORRIS IL
60450-1334
US

IV. Provider business mailing address

725 SCHOOL ST STE A
MORRIS IL
60450-1207
US

V. Phone/Fax

Practice location:
  • Phone: 815-941-0441
  • Fax:
Mailing address:
  • Phone: 815-941-9124
  • Fax: 815-941-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036118254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: