Provider Demographics
NPI:1699317339
Name:OCHOA LA O, GRETHER LILIET
Entity type:Individual
Prefix:
First Name:GRETHER
Middle Name:LILIET
Last Name:OCHOA LA O
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 1:15136 SW 63RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2052
Mailing Address - Country:US
Mailing Address - Phone:786-985-8405
Mailing Address - Fax:
Practice Address - Street 1:8300 W FLAGLER ST STE 258C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-6002
Practice Address - Country:US
Practice Address - Phone:786-633-5171
Practice Address - Fax:786-558-9279
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-48555103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst