Healthcare Provider Details

I. General information

NPI: 1730251596
Provider Name (Legal Business Name): MARY KIMBERLY DESROCHES D.C., B.P.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7217 PAINTER AVE
WHITTIER CA
90602-1451
US

IV. Provider business mailing address

12117 RAMSEY DR
WHITTIER CA
90605-4039
US

V. Phone/Fax

Practice location:
  • Phone: 562-392-0627
  • Fax: 562-324-6846
Mailing address:
  • Phone: 562-392-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC28306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: