Basic Information
Provider Information
NPI: 1659821379
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OCHOA
FirstName: SARAH
MiddleName: JANE
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7777 S REDWOOD RD
Address2:  
City: WEST JORDAN
State: UT
PostalCode: 840845518
CountryCode: US
TelephoneNumber: 8012559077
FaxNumber:  
Practice Location
Address1: 2000 CIRCLE OF HOPE DR
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841125550
CountryCode: US
TelephoneNumber: 8015877000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/05/2016
LastUpdateDate: 03/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X12021262-4405UTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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