Healthcare Provider Details

I. General information

NPI: 1730970385
Provider Name (Legal Business Name): BONAVENTURE OROCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12234 APACHE TEARS CIR
LAUREL MD
20708-2847
US

IV. Provider business mailing address

12234 APACHE TEARS CIR
LAUREL MD
20708-2847
US

V. Phone/Fax

Practice location:
  • Phone: 240-784-3133
  • Fax:
Mailing address:
  • Phone: 240-784-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: