Provider Demographics
NPI:1992804454
Name:OCHOA, GRACE MATI (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:MATI
Last Name:OCHOA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE IB
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1304
Mailing Address - Country:US
Mailing Address - Phone:818-781-6900
Mailing Address - Fax:818-781-5368
Practice Address - Street 1:6411 SEPULVEDA BLVD
Practice Address - Street 2:SUITE IB
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1304
Practice Address - Country:US
Practice Address - Phone:818-781-6900
Practice Address - Fax:818-781-5368
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADV0387171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38717-01OtherDENTICAL