Provider Demographics
NPI:1134399058
Name:OCHOA, ANDREA GAILE (RPA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:GAILE
Last Name:OCHOA
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:110 CENTRAL AVE
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-0070
Mailing Address - Country:US
Mailing Address - Phone:607-687-5333
Mailing Address - Fax:
Practice Address - Street 1:110 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1311
Practice Address - Country:US
Practice Address - Phone:607-687-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant