Basic Information
Provider Information
NPI: 1427389105
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OCHOA
FirstName: SUSANA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6900 ADAMSON AVE
Address2:  
City: BELL GARDENS
State: CA
PostalCode: 902014020
CountryCode: US
TelephoneNumber: 3239070128
FaxNumber:  
Practice Location
Address1: 1000 GOODRICH BLVD
Address2:  
City: COMMERCE
State: CA
PostalCode: 900225103
CountryCode: US
TelephoneNumber: 3238329795
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/20/2010
LastUpdateDate: 01/20/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X27358CAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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