Healthcare Provider Details

I. General information

NPI: 1255171583
Provider Name (Legal Business Name): HENRIQUE OCHOA SCUSSIATTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3927 OSVALDO CRUZ STREET HOUSE 2
CASCAVEL PR
81811
BR

IV. Provider business mailing address

3927 OSVALDO CRUZ STREET HOUSE 2
CASCAVEL PR
81811
BR

V. Phone/Fax

Practice location:
  • Phone: 459-882-5976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125084504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: