Healthcare Provider Details

I. General information

NPI: 1740295138
Provider Name (Legal Business Name): ROBERT P ROCCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SUNSET DR SUITE 1
HOLLISTER CA
95023-5613
US

IV. Provider business mailing address

PO BOX 1870
WATSONVILLE CA
95077-1870
US

V. Phone/Fax

Practice location:
  • Phone: 831-637-1655
  • Fax: 831-637-6894
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA26562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: