Healthcare Provider Details

I. General information

NPI: 1821481193
Provider Name (Legal Business Name): ROLANDO JAVIER ROCHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 BURLINGTON AVE
WESTERN SPRINGS IL
60558-1516
US

IV. Provider business mailing address

1023 BURLINGTON AVE
WESTERN SPRINGS IL
60558-1516
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-0826
  • Fax:
Mailing address:
  • Phone: 708-354-0826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: