Healthcare Provider Details

I. General information

NPI: 1619345808
Provider Name (Legal Business Name): IRENE OCHOA CADC 1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE CAMPOS

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 NE EVANS ST
MCMINNVILLE OR
97128-3923
US

IV. Provider business mailing address

8450 SE AMITY DAYTON HWY
MCMINNVILLE OR
97128-8710
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-7523
  • Fax:
Mailing address:
  • Phone: 971-267-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: