Provider Demographics
NPI:1699900480
Name:OCHOA, LYSSA N (MD)
Entity type:Individual
Prefix:DR
First Name:LYSSA
Middle Name:N
Last Name:OCHOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E AMBER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-2456
Mailing Address - Country:US
Mailing Address - Phone:210-610-7283
Mailing Address - Fax:210-812-5938
Practice Address - Street 1:603 E AMBER ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-2456
Practice Address - Country:US
Practice Address - Phone:210-610-7283
Practice Address - Fax:210-812-5938
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2693208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281711603Medicaid
TX281711601Medicaid