Healthcare Provider Details

I. General information

NPI: 1881683951
Provider Name (Legal Business Name): NORMA J ROCHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 N HOMESTEAD BLVD #104
HOMESTEAD FL
33030-6207
US

IV. Provider business mailing address

PO BOX 924308
PRINCETON FL
33092-4308
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:
Title or Position:
Credential:
Phone: