Healthcare Provider Details

I. General information

NPI: 1962811109
Provider Name (Legal Business Name): RENADA ROCHON ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 WURZBACH RD
SAN ANTONIO TX
78238-2422
US

IV. Provider business mailing address

11610 GULF STATION
HELOTES TX
78023
US

V. Phone/Fax

Practice location:
  • Phone: 210-647-4671
  • Fax:
Mailing address:
  • Phone: 505-507-3273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAP123425
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: