Healthcare Provider Details

I. General information

NPI: 1376102269
Provider Name (Legal Business Name): ANDRE A. ROCHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N ROYAL ST
ANAHEIM CA
92806-3235
US

IV. Provider business mailing address

524 N ROYAL ST
ANAHEIM CA
92806-3235
US

V. Phone/Fax

Practice location:
  • Phone: 714-980-3115
  • Fax:
Mailing address:
  • Phone: 714-980-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number31438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: