Healthcare Provider Details

I. General information

NPI: 1063638260
Provider Name (Legal Business Name): GLORIA OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E MAIN ST STE 600
OTHELLO WA
99344-1146
US

IV. Provider business mailing address

425 E MAIN ST STE 600
OTHELLO WA
99344-1146
US

V. Phone/Fax

Practice location:
  • Phone: 509-488-4074
  • Fax: 509-488-0166
Mailing address:
  • Phone: 509-488-4074
  • Fax: 509-488-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00000510
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: