Healthcare Provider Details

I. General information

NPI: 1730726738
Provider Name (Legal Business Name): PATRICIA ROCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

14100 GLENGYLE ST
WHITTIER CA
90604-2434
US

IV. Provider business mailing address

11403 DICKY ST
WHITTIER CA
90606-2326
US

V. Phone/Fax

Practice location:
  • Phone: 562-777-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: