Provider Demographics
NPI:1548534944
Name:OCHOA, JUAN RUBEN JR (LPT LICENSE)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:RUBEN
Last Name:OCHOA
Suffix:JR
Gender:M
Credentials:LPT LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26359 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:CA
Mailing Address - Zip Code:92318
Mailing Address - Country:US
Mailing Address - Phone:909-254-3948
Mailing Address - Fax:
Practice Address - Street 1:26359 FIRST ST
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:CA
Practice Address - Zip Code:92318-0230
Practice Address - Country:US
Practice Address - Phone:909-254-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36327167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician