Healthcare Provider Details

I. General information

NPI: 1891209359
Provider Name (Legal Business Name): ROC MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 10/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N CALIFORNIA ST STE 406
STOCKTON CA
95204-6033
US

IV. Provider business mailing address

1805 N CALIFORNIA ST STE 406
STOCKTON CA
95204-6033
US

V. Phone/Fax

Practice location:
  • Phone: 209-227-7806
  • Fax: 209-851-3853
Mailing address:
  • Phone: 209-227-7806
  • Fax: 209-851-3853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA93056
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA93056
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD O CAMACHO
Title or Position: OWNER
Credential: M.D.
Phone: 209-227-7806