Healthcare Provider Details

I. General information

NPI: 1437096823
Provider Name (Legal Business Name): BROC R BOCHES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 CAMINO DEL RIO N STE 450
SAN DIEGO CA
92108-1603
US

IV. Provider business mailing address

2655 CAMINO DEL RIO N STE 450
SAN DIEGO CA
92108-1603
US

V. Phone/Fax

Practice location:
  • Phone: 619-633-4115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: