Healthcare Provider Details

I. General information

NPI: 1891345716
Provider Name (Legal Business Name): SEMIR ROCEVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 EVANS LN
SAN JOSE CA
95125-2072
US

IV. Provider business mailing address

2090 EVANS LN
SAN JOSE CA
95125-2072
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-2400
  • Fax: 408-448-1815
Mailing address:
  • Phone: 408-793-2400
  • Fax: 408-448-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW117222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: