Healthcare Provider Details

I. General information

NPI: 1811992530
Provider Name (Legal Business Name): PIRA ROCHANAYON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7311 GREENHAVEN DR STE 125
SACRAMENTO CA
95831-3595
US

IV. Provider business mailing address

7311 GREENHAVEN DR STE 125
SACRAMENTO CA
95831-3595
US

V. Phone/Fax

Practice location:
  • Phone: 916-399-1171
  • Fax: 916-399-1082
Mailing address:
  • Phone: 916-399-1171
  • Fax: 916-399-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC42420
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC42420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: