Provider Demographics
NPI:1912606138
Name:OCHOA, NICOLE DESIREE (PTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DESIREE
Last Name:OCHOA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 TOCINO DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1445
Mailing Address - Country:US
Mailing Address - Phone:626-506-1763
Mailing Address - Fax:
Practice Address - Street 1:14001 RAMONA BLVD STE E
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3232
Practice Address - Country:US
Practice Address - Phone:626-941-2559
Practice Address - Fax:626-364-7760
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50396225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant