Healthcare Provider Details

I. General information

NPI: 1336340926
Provider Name (Legal Business Name): CONSTANCE JEAN ROCK L.M., C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19920 NICHOLAS WAY
LOWER LAKE CA
95457-9162
US

IV. Provider business mailing address

4859 OLD REDWOOD HWY
SANTA ROSA CA
95403-1415
US

V. Phone/Fax

Practice location:
  • Phone: 818-324-2678
  • Fax: 636-334-2631
Mailing address:
  • Phone: 707-387-2088
  • Fax: 707-324-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCA117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: