Provider Demographics
NPI:1548454705
Name:OCHOA, MAIKO NICOLE (PT)
Entity type:Individual
Prefix:MS
First Name:MAIKO
Middle Name:NICOLE
Last Name:OCHOA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 FRIAR PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4409
Mailing Address - Country:US
Mailing Address - Phone:619-244-1767
Mailing Address - Fax:
Practice Address - Street 1:1442 FRIAR PL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4409
Practice Address - Country:US
Practice Address - Phone:619-244-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71743183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician