Healthcare Provider Details

I. General information

NPI: 1972162709
Provider Name (Legal Business Name): RUBI JESENIA ROCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 AIRPORT BLVD STE 490
BURLINGAME CA
94010-1945
US

IV. Provider business mailing address

700 AIRPORT BLVD STE 490
BURLINGAME CA
94010-1945
US

V. Phone/Fax

Practice location:
  • Phone: 650-465-6641
  • Fax: 650-517-8239
Mailing address:
  • Phone: 650-465-6641
  • Fax: 650-517-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: