Basic Information
| Provider Information | |||||||||
| NPI: | 1679975304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OCHOA | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | CORINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10992 PINON AVE | ||||||||
| Address2: | |||||||||
| City: | HESPERIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923452249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608101012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 658 E BRIER DRIVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924153574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095010700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2014 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | 101944 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 101YA0400X | 05 | CA | MEDICAID |