Provider Demographics
NPI:1255171583
Name:OCHOA SCUSSIATTO, HENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:HENRIQUE
Middle Name:
Last Name:OCHOA SCUSSIATTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 OSVALDO CRUZ STREET
Mailing Address - Street 2:HOUSE 2
Mailing Address - City:CASCAVEL
Mailing Address - State:PR
Mailing Address - Zip Code:81811
Mailing Address - Country:BR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3927 OSVALDO CRUZ STREET
Practice Address - Street 2:HOUSE 2
Practice Address - City:CASCAVEL
Practice Address - State:PR
Practice Address - Zip Code:81811
Practice Address - Country:BR
Practice Address - Phone:459-882-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125084504208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery