Healthcare Provider Details

I. General information

NPI: 1083092209
Provider Name (Legal Business Name): JOSE JAVIER ROCHA RDHAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMFIELD AVE
COMMERCE CA
90040-1574
US

IV. Provider business mailing address

1516 W FRANCES DR
ANAHEIM CA
92801-3637
US

V. Phone/Fax

Practice location:
  • Phone: 323-725-8751
  • Fax:
Mailing address:
  • Phone: 562-396-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP979
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number28280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: