Healthcare Provider Details

I. General information

NPI: 1699530766
Provider Name (Legal Business Name): DANIEL ROCHA DN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW STE 130
ALBUQUERQUE NM
87102-3326
US

IV. Provider business mailing address

400 GOLD AVE SW STE 130
ALBUQUERQUE NM
87102-3326
US

V. Phone/Fax

Practice location:
  • Phone: 505-451-1303
  • Fax:
Mailing address:
  • Phone: 505-451-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License NumberDN2024-003
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT20230035
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: