Healthcare Provider Details

I. General information

NPI: 1598885238
Provider Name (Legal Business Name): KATHLEEN RAE ROCHE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E VALLEY PKWY
ESCONDIDO CA
92025-3008
US

IV. Provider business mailing address

2810 CHATSWORTH WAY
CARLSBAD CA
92010-7011
US

V. Phone/Fax

Practice location:
  • Phone: 760-740-4020
  • Fax: 760-740-4003
Mailing address:
  • Phone: 760-729-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number364753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: