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NPI Code Detail

MEDICARE: JESSICA LA ROCCA

MEDICARE: JESSICA LA ROCCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist91103CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D9196224OTHERCADMV

General Provider Information

NPI Number : 1154987832
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LA ROCCA
Provider Business Mailing Address
First Line : 4500 VIA MARINA APT 209
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-7219
Country : US
Telephone Number : 510-828-7816
Fax Number :
Provider Business Practice Location Address
First Line : 12304 SANTA MONICA BLVD STE 327
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-7207
Country : US
Telephone Number : 510-828-7816
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2019
Last Update Date : 06/11/2019

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Directions to “ JESSICA LA ROCCA ” Practice Location

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