Provider Demographics
NPI:1336426469
Name:OCHOA, JORGE LUIS
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name: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 1:200 SW 113 AVE # 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1169
Mailing Address - Country:US
Mailing Address - Phone:305-508-8847
Mailing Address - Fax:
Practice Address - Street 1:200 SW 113 AVE
Practice Address - Street 2:# 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1169
Practice Address - Country:US
Practice Address - Phone:305-508-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 63281111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 63281OtherMASSAGE THERAPY