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General NPI Number Information
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NPI Number | 1568509164
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Entity Type | Individual
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Provider Name | JOSE JULIAN DE LA ROCHA PA
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 13111 US HIGHWAY 301 S
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City | RIVERVIEW
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State | FL
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Zip | 33578-7401
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Country | US
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Telephone | 813-671-0064
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Fax | 813-672-2153
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Provider Business Mailing Address
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Address Line | 9124 EGRET COVE CIR
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City | RIVERVIEW
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State | FL
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Zip | 33578-3113
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Country | US
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Telephone | 813-416-5673
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3333
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License Number State | FL
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