Healthcare Provider Details

I. General information

NPI: 1376243501
Provider Name (Legal Business Name): BIFF ROCHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOUR SEASONS DRIVE APT 504
MASON OH
45040
US

IV. Provider business mailing address

500 FOUR SEASONS DRIVE APT 504
MASON OH
45040
US

V. Phone/Fax

Practice location:
  • Phone: 937-750-1688
  • Fax:
Mailing address:
  • Phone: 937-750-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: