Basic Information
Provider Information
NPI: 1538296868
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OCHOA
FirstName: CHRISTINE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MALITZ
OtherFirstName: CHRISTINE
OtherMiddleName: L
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 496048
Address2:  
City: REDDING
State: CA
PostalCode: 960496048
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2640 BRESLAUER WAY
Address2:  
City: REDDING
State: CA
PostalCode: 960014246
CountryCode: US
TelephoneNumber: 5302255200
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/27/2007
LastUpdateDate: 07/19/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0808X505989CAY Nursing Service ProvidersRegistered NursePsych/Mental Health

No ID Information.


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