Provider Demographics
NPI:1275757940
Name:OCHOA, JOSE JR (CADCII, ICADC)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:OCHOA
Suffix:JR
Gender:M
Credentials:CADCII, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4933
Mailing Address - Country:US
Mailing Address - Phone:951-791-3350
Mailing Address - Fax:951-791-3353
Practice Address - Street 1:1370 S STATE ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4933
Practice Address - Country:US
Practice Address - Phone:951-791-3350
Practice Address - Fax:951-791-3353
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA012080315171M00000X, 101YA0400X
CA127312101YA0400X
CAA6840911101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator