Provider Demographics
NPI:1659738920
Name:PEREA OCHOA, JESUS
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:PEREA OCHOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 E AIRPORT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7812
Mailing Address - Country:US
Mailing Address - Phone:909-937-3400
Mailing Address - Fax:909-937-3411
Practice Address - Street 1:4355 E AIRPORT DR STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7812
Practice Address - Country:US
Practice Address - Phone:909-937-3400
Practice Address - Fax:909-937-3411
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant