Provider Demographics
NPI:1407093800
Name:OCHOA, JACKIE ANNETTE
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:ANNETTE
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 1:7001 WALKER AVE
Mailing Address - Street 2:#D
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-2942
Mailing Address - Country:US
Mailing Address - Phone:323-636-6680
Mailing Address - Fax:
Practice Address - Street 1:179 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7716
Practice Address - Country:US
Practice Address - Phone:714-288-1035
Practice Address - Fax:714-288-2784
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60389126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant