Provider Demographics
NPI:1134367428
Name:OCHOA, JENNIFER (EDD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:OCHOA
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 SW 137TH AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6332
Mailing Address - Country:US
Mailing Address - Phone:305-228-4731
Mailing Address - Fax:
Practice Address - Street 1:2450 SW 137TH AVE STE 221
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6333
Practice Address - Country:US
Practice Address - Phone:305-228-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000525300Medicaid