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General NPI Number Information
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NPI Number | 1740609072
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Entity Type | Individual
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Provider Name | LEDY TATIANA OCHOA
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Gender | Female
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 345 SW 113TH LN
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-4830
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Country | US
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Telephone | 954-907-1424
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Fax |
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Provider Business Mailing Address
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Address Line | 345 SW 113TH LN
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-4830
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Country | US
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Telephone | 954-907-1424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9107873
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License Number State | FL
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