Healthcare Provider Details

I. General information

NPI: 1790375160
Provider Name (Legal Business Name): ANDREA M OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 S 3200 W STE 2
WEST JORDAN UT
84084-2887
US

IV. Provider business mailing address

5717 S LOLENE WAY
TAYLORSVILLE UT
84129-1917
US

V. Phone/Fax

Practice location:
  • Phone: 801-915-0359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12886007-3501
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: