Provider Demographics
NPI:1407172083
Name:OCHOA REINA, OLGA LUCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:LUCIA
Last Name:OCHOA REINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5635 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4438
Mailing Address - Country:US
Mailing Address - Phone:312-682-6110
Mailing Address - Fax:773-649-6331
Practice Address - Street 1:5635 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4438
Practice Address - Country:US
Practice Address - Phone:312-682-6110
Practice Address - Fax:773-649-6331
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60274567208000000X
IL036131818208000000X
IL036131828208000000X
IL131818208000000X
IN01077152A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics