Provider Demographics
NPI:1225560709
Name:OCHOA, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:OCHOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 TALBOT BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-1864
Mailing Address - Country:US
Mailing Address - Phone:954-651-1199
Mailing Address - Fax:
Practice Address - Street 1:6431 LAKE ANDREW DR UNIT 105
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7250
Practice Address - Country:US
Practice Address - Phone:321-522-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN265011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice