Provider Demographics
NPI:1750587531
Name:OCHOA, JOHN L (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:OCHOA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BURR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1926
Mailing Address - Country:US
Mailing Address - Phone:631-757-2061
Mailing Address - Fax:631-757-2061
Practice Address - Street 1:41 BURR AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1926
Practice Address - Country:US
Practice Address - Phone:631-757-2061
Practice Address - Fax:631-757-2061
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical