Healthcare Provider Details

I. General information

NPI: 1548940406
Provider Name (Legal Business Name): JUSTIN MICHAEL ROCHA SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23824 HAWTHORNE BOULEVARD SUITE 200
TORRANCE CA
90505
US

IV. Provider business mailing address

23824 HAWTHORNE BOULEVARD SUITE 200
TORRANCE CA
90505
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-3064
  • Fax:
Mailing address:
  • Phone: 310-791-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC14277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: