Healthcare Provider Details

I. General information

NPI: 1013665108
Provider Name (Legal Business Name): SAMANTHA ROCHA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 E RENNER RD STE 201
RICHARDSON TX
75082-2227
US

IV. Provider business mailing address

1410 E RENNER RD STE 201
RICHARDSON TX
75082-2227
US

V. Phone/Fax

Practice location:
  • Phone: 972-234-3311
  • Fax: 972-669-8072
Mailing address:
  • Phone: 972-234-3311
  • Fax: 972-669-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: