MEDICARE: ELISA NICOLE OCHOA M.S. BCBA LBA

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	103K00000X	Behavior Analyst	BEH-001935	AZ

General Provider Information

NPI Number	:	1982213369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA NICOLE OCHOA M.S. BCBA LBA

Provider Business Mailing Address
First Line	:	22363 E DOMINGO RD STE 105-106
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-0352
Country	:	US
Telephone Number	:	602-887-1383
Fax Number	:

Provider Business Practice Location Address
First Line	:	22363 E DOMINGO RD STE 105-106
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-0352
Country	:	US
Telephone Number	:	602-887-1383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	06/22/2026

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