Healthcare Provider Details

I. General information

NPI: 1801230891
Provider Name (Legal Business Name): EVITA MARIE ROCHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 CANYON CREST DR
RIVERSIDE CA
92507-6301
US

IV. Provider business mailing address

7060 CLAIREMONT MESA BLVD
SAN DIEGO CA
92111-1003
US

V. Phone/Fax

Practice location:
  • Phone: 909-856-8791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA138937
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA138937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: