Provider Demographics
NPI:1538651849
Name:OCHOA, JONATHAN IGNACIO
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:IGNACIO
Last Name:OCHOA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 ATHOL ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3712
Mailing Address - Country:US
Mailing Address - Phone:323-580-7954
Mailing Address - Fax:
Practice Address - Street 1:139 W INGLENOOK DR APT 2417
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5391
Practice Address - Country:US
Practice Address - Phone:323-580-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF50927742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer