Provider Demographics
NPI:1730601311
Name:MATA, RICARDO OCHOA
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:OCHOA
Last Name:MATA
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 1:705 NIDO DR APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-4815
Mailing Address - Country:US
Mailing Address - Phone:831-737-6125
Mailing Address - Fax:
Practice Address - Street 1:5671 SANTA TERESA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6515
Practice Address - Country:US
Practice Address - Phone:408-225-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst