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General NPI Number Information
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NPI Number | 1932849643
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Entity Type | Individual
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Provider Name | LAECIO LACERDA ROCHA MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 9710 STATE AVE
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City | MARYSVILLE
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State | WA
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Zip | 98270-2232
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Country | US
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Telephone | 360-531-7423
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Fax | 360-512-2026
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Provider Business Mailing Address
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Address Line | PO BOX 34703
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City | SEATTLE
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State | WA
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Zip | 98124-1703
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Country | US
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Telephone |
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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 | MD61615434
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | MD61615434
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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