Provider Demographics
NPI:1124786611
Name:OCHOA, MARIA DOLORES (CERTIFIED)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:OCHOA
Suffix:
Gender:F
Credentials:CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 53RD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4329
Mailing Address - Country:US
Mailing Address - Phone:917-945-9543
Mailing Address - Fax:
Practice Address - Street 1:8602 53RD AVE FL 1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4329
Practice Address - Country:US
Practice Address - Phone:917-945-9543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY800203787OtherHEALTH FIRST