MEDICARE: YUMA VALLEY FAMILY MEDICINE CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	36865	AZ

General Provider Information

NPI Number	:	1164619896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YUMA VALLEY FAMILY MEDICINE CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 330
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85366-2313
Country	:	US
Telephone Number	:	928-782-1903
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 S 8TH AVE
Second Line	:	STE B
City	:	YUMA
State	:	AZ
Zip	:	85364-7154
Country	:	US
Telephone Number	:	928-782-1903
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICKY OCHOA
Credential	:	MD
Telephone Number	:	928-782-1903

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	12/10/2018

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