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General NPI Number Information
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NPI Number | 1053863456
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Entity Type | Organization
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Legal Business Name | MARIA DE JESUS ROCHA
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | CALLE EMPALME # 1 LA MESA
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City | TIJUANA
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State | BAJA CALIFORNIA
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Zip | 22195
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Country | MX
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Telephone | 664-681-6854
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Fax | 866-272-6924
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Provider Business Mailing Address
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Address Line | 4275 EXECUTIVE SQ STE 200
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City | LA JOLLA
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State | CA
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Zip | 92037-9123
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Country | US
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Telephone | 800-743-3900
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Fax | 866-272-6924
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MA RIA DE JESUS ROCHA
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Credential | DDS
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Telephone | 800-743-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1787406
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License Number State | ZZ
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