Provider Demographics
NPI:1558820043
Name:OCHOA, GABRIELA C (PEER SUPPORT WORKER)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:C
Last Name:OCHOA
Suffix:
Gender:F
Credentials:PEER SUPPORT WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 MCNUTT RD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9056
Mailing Address - Country:US
Mailing Address - Phone:575-915-1338
Mailing Address - Fax:575-915-1819
Practice Address - Street 1:2801 MISSOURI AVE STE 38
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9151
Practice Address - Country:US
Practice Address - Phone:575-636-2550
Practice Address - Fax:575-915-1644
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM175T00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No175T00000XOther Service ProvidersPeer Specialist