Provider Demographics
NPI:1083314421
Name:PINTO-OCHOA, MIA VANESSA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:VANESSA
Last Name:PINTO-OCHOA
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 BIRDSEYE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6045
Mailing Address - Country:US
Mailing Address - Phone:916-803-6338
Mailing Address - Fax:
Practice Address - Street 1:4313 BIRDSEYE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6045
Practice Address - Country:US
Practice Address - Phone:916-803-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024359364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care