Provider Demographics
NPI:1063711067
Name:OCHOA, KELLY MARIE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:OCHOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:MACKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 TOWN CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1117
Mailing Address - Country:US
Mailing Address - Phone:559-797-1686
Mailing Address - Fax:
Practice Address - Street 1:1000 TOWN CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1117
Practice Address - Country:US
Practice Address - Phone:559-797-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115696208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics