Provider Demographics
NPI:1912530338
Name:ACEVES OCHOA, KRYSTAL DENICE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DENICE
Last Name:ACEVES OCHOA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5065 DEER VALLEY RD STE 248
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-5200
Mailing Address - Country:US
Mailing Address - Phone:925-501-5731
Mailing Address - Fax:
Practice Address - Street 1:5065 DEER VALLEY RD STE 248
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-5200
Practice Address - Country:US
Practice Address - Phone:925-501-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-25-79856103K00000X
CARBT-21-183218106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst