Healthcare Provider Details

I. General information

NPI: 1114973542
Provider Name (Legal Business Name): MARGO H ROCA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MARGO NAN HIRSHMAN

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 UTAH AVE STE 200
EL SEGUNDO CA
90245-4817
US

IV. Provider business mailing address

18451 MEYER AVE
PORT CHARLOTTE FL
33948-8931
US

V. Phone/Fax

Practice location:
  • Phone: 281-766-0959
  • Fax:
Mailing address:
  • Phone: 941-628-9015
  • Fax: 941-766-9766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME0064433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: