Healthcare Provider Details

I. General information

NPI: 1508908740
Provider Name (Legal Business Name): EDDIE ERNESTO ROCA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVE ROOM 2303
MIAMI FL
33136-1409
US

IV. Provider business mailing address

1695 NW 9TH AVE ROOM 2303
MIAMI FL
33136-1409
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-8245
  • Fax: 305-355-8235
Mailing address:
  • Phone: 305-355-8245
  • Fax: 305-355-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY2550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: