Healthcare Provider Details

I. General information

NPI: 1760823462
Provider Name (Legal Business Name): MARISA ROSALINDA OCHOA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 4TH ST NW
ALBUQUERQUE NM
87107-3902
US

IV. Provider business mailing address

805 MARCELLA ST NE
ALBUQUERQUE NM
87123-1240
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-1390
  • Fax:
Mailing address:
  • Phone: 505-917-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007982
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: