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General NPI Number Information
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NPI Number | 1639371628
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Entity Type | Individual
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Provider Name | LAURO LUCIO ROCHA APRN,BC
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Gender | Male
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Dates
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Enumeration Date | 06/03/2007
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 562 W SIDE AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07304-1618
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Country | US
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Telephone | 201-434-7800
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Fax | 201-434-6715
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Provider Business Mailing Address
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Address Line | 562 W SIDE AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07304-1618
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Country | US
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Telephone | 201-434-7800
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Fax | 201-434-6715
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00133200
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License Number State | NJ
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