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General NPI Number Information
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NPI Number | 1548260052
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Entity Type | Individual
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Provider Name | PATRICIA MAGDALENA ROCHA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 1423 E ROOSEVELT AVENUE
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City | GRANTS
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State | NM
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Zip | 87020-2118
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Country | US
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Telephone | 505-287-6500
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Fax | 505-287-9053
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Provider Business Mailing Address
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Address Line | 1423 E ROOSEVELT AVE
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City | GRANTS
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State | NM
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Zip | 87020-2245
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Country | US
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Telephone | 505-287-6500
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Fax | 505-287-9053
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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 | A92197
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2004-0636
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License Number State | NM
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