MEDICARE: BRICEIDA ROCHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL11404H	AZ

General Provider Information

NPI Number	:	1417562406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRICEIDA ROCHA

Provider Business Mailing Address
First Line	:	1345 W ATLANTA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-3929
Country	:	US
Telephone Number	:	951-250-1242
Fax Number	:	602-806-9901

Provider Business Practice Location Address
First Line	:	1345 W ATLANTA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-3929
Country	:	US
Telephone Number	:	951-250-1242
Fax Number	:	602-806-9901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	04/26/2024

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Directions to “ BRICEIDA ROCHA ” Practice Location

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