Provider Demographics
NPI:1073269619
Name:OCHOA NAVARRO, DIANA YUDIT
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:YUDIT
Last Name:OCHOA NAVARRO
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 1:7975 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-1003
Mailing Address - Country:US
Mailing Address - Phone:786-343-9402
Mailing Address - Fax:
Practice Address - Street 1:7975 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-1003
Practice Address - Country:US
Practice Address - Phone:786-343-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB620506106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBACB620506Medicaid