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General NPI Number Information
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NPI Number | 1164619896
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Entity Type | Organization
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Legal Business Name | YUMA VALLEY FAMILY MEDICINE CENTER PC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 2741 S 8TH AVE STE B
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City | YUMA
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State | AZ
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Zip | 85364-7154
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Country | US
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Telephone | 928-782-1903
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 330
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City | YUMA
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State | AZ
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Zip | 85366-2313
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Country | US
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Telephone | 928-782-1903
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICKY OCHOA
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Credential | MD
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Telephone | 928-782-1903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36865
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License Number State | AZ
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