Healthcare Provider Details

I. General information

NPI: 1942599600
Provider Name (Legal Business Name): MARTIN ROCHA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N HIGHWAY 173, SUITE 6
LAKE ARROWHEAD CA
92321-0716
US

IV. Provider business mailing address

PO BOX 716
CEDAR GLEN CA
92321-0716
US

V. Phone/Fax

Practice location:
  • Phone: 909-336-3670
  • Fax: 909-336-3674
Mailing address:
  • Phone: 909-336-3670
  • Fax: 909-336-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN ROCHA SR.
Title or Position: OWNER
Credential: M.D.
Phone: 909-659-2850