Provider Demographics
NPI:1316777857
Name:CRUZ OCHOA, FRIDA NICOLE
Entity type:Individual
Prefix:
First Name:FRIDA
Middle Name:NICOLE
Last Name:CRUZ OCHOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535
Mailing Address - Country:US
Mailing Address - Phone:541-778-1724
Mailing Address - Fax:541-535-5458
Practice Address - Street 1:149 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535
Practice Address - Country:US
Practice Address - Phone:541-778-1724
Practice Address - Fax:541-535-5458
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)