Healthcare Provider Details

I. General information

NPI: 1841037223
Provider Name (Legal Business Name): VERONICA OTHON ROCCA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2549 W SHAW AVE
FRESNO CA
93711-3308
US

IV. Provider business mailing address

2549 W SHAW AVE
FRESNO CA
93711-3308
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax: 559-860-0168
Mailing address:
  • Phone: 559-264-7521
  • Fax: 559-860-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number731108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: