Healthcare Provider Details

I. General information

NPI: 1124368535
Provider Name (Legal Business Name): NORMA ROCHE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 N HOMESTEAD BLVD STE 104
HOMESTEAD FL
33030-6208
US

IV. Provider business mailing address

698 N HOMESTEAD BLVD STE 104
HOMESTEAD FL
33030-6208
US

V. Phone/Fax

Practice location:
  • Phone: 305-245-3534
  • Fax: 305-245-3563
Mailing address:
  • Phone: 305-245-3534
  • Fax: 305-245-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME87339
License Number StateFL

VIII. Authorized Official

Name: NORMA ROCHE
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-245-3534