Healthcare Provider Details

I. General information

NPI: 1679091870
Provider Name (Legal Business Name): MS. LAURA EVELYN ROCHELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 HIHN RD
BEN LOMOND CA
95005-9660
US

IV. Provider business mailing address

380 ENCINAL ST STE 200
SANTA CRUZ CA
95060-2178
US

V. Phone/Fax

Practice location:
  • Phone: 831-600-5169
  • Fax:
Mailing address:
  • Phone: 831-469-1700
  • Fax: 831-425-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: