Provider Demographics
NPI:1750435988
Name:OCHOA-GRIJALVA, JOSE FERNANDO
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FERNANDO
Last Name:OCHOA-GRIJALVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:253-681-6603
Mailing Address - Fax:
Practice Address - Street 1:1400 N LAVENTURE RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2766
Practice Address - Country:US
Practice Address - Phone:360-542-8901
Practice Address - Fax:360-542-8790
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00243311223P0221X
WADE601199611223P0221X
TNDS000008531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry