Healthcare Provider Details

I. General information

NPI: 1902667025
Provider Name (Legal Business Name): ROCHELLE DENISE FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 7TH AVE
SAN BRUNO CA
94066-4522
US

IV. Provider business mailing address

18764 W BYRON RD # 210
TRACY CA
95391-9713
US

V. Phone/Fax

Practice location:
  • Phone: 650-204-3113
  • Fax: 650-244-1777
Mailing address:
  • Phone: 650-244-1444
  • Fax: 650-244-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: