Provider Demographics
NPI:1376674770
Name:MARIO A. OCHOA M.D. INC
Entity Type:Organization
Organization Name:MARIO A. OCHOA M.D. INC
Other - Org Name:DR. OCHOA FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-896-3808
Mailing Address - Street 1:3275 MCCALL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-2505
Mailing Address - Country:US
Mailing Address - Phone:559-896-3808
Mailing Address - Fax:559-896-3875
Practice Address - Street 1:3275 MCCALL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2505
Practice Address - Country:US
Practice Address - Phone:559-896-3808
Practice Address - Fax:559-896-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A764171Medicaid
CAZZZ02476ZMedicare ID - Type Unspecified