Healthcare Provider Details

I. General information

NPI: 1750942017
Provider Name (Legal Business Name): ANDREA OCHOA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 WASHINGTON ST
MOUNT VERNON NY
10553-1052
US

IV. Provider business mailing address

28 PARK PL
NEW ROCHELLE NY
10801-4208
US

V. Phone/Fax

Practice location:
  • Phone: 914-613-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number723040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: