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General NPI Number Information
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NPI Number | 1083894075
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Entity Type | Individual
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Provider Name | GOWRI REDDY ROCCO M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 11705 SLATE AVE STE 200
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City | RIVERSIDE
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State | CA
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Zip | 92505-5199
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Country | US
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Telephone | 949-375-0224
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Fax |
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Provider Business Mailing Address
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Address Line | 1643 ZURITA CIR
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City | CORONA
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State | CA
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Zip | 92881-8809
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Country | US
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Telephone | 951-808-0171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C52555
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License Number State | CA
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