=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104967124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH LOUISE ROCHELLE MFCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 327 S IVY ST
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-4337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-484-7829
-----------------------------------------------------
Fax | 760-294-2151
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12544 CHETENHAM LN
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-451-3317
-----------------------------------------------------
Fax | 858-451-3317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC38413
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------