Healthcare Provider Details

I. General information

NPI: 1063876340
Provider Name (Legal Business Name): ROCA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10393 LEAGUE LINE RD
CONROE TX
77304-1028
US

IV. Provider business mailing address

4500 N MESA ST
EL PASO TX
79912-6102
US

V. Phone/Fax

Practice location:
  • Phone: 915-373-3766
  • Fax:
Mailing address:
  • Phone: 915-373-3766
  • Fax: 915-532-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK9162
License Number StateTX

VIII. Authorized Official

Name: RUBEN R RONCALLO
Title or Position: PRESIDENT
Credential: MD
Phone: 915-373-3766