Provider Demographics
NPI:1275237760
Name:OCHOA, BETSY
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:OCHOA
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 1:2677 LEDOUX AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5459
Mailing Address - Country:US
Mailing Address - Phone:602-930-7679
Mailing Address - Fax:
Practice Address - Street 1:2677 LEDOUX AVE APT 304
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5459
Practice Address - Country:US
Practice Address - Phone:602-930-7679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator