Provider Demographics
NPI:1033616131
Name:OCHOA, BARON JOSPEH (IDC)
Entity Type:Individual
Prefix:
First Name:BARON
Middle Name:JOSPEH
Last Name:OCHOA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A66 RIVER BASIN ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0183
Mailing Address - Country:US
Mailing Address - Phone:910-440-7704
Mailing Address - Fax:
Practice Address - Street 1:A66 RIVER BASIN RD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28452
Practice Address - Country:US
Practice Address - Phone:910-440-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
1363972973OtherTRICARE