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NPI Code Detail

MEDICARE: DR. BERNARDINO L.V.C.B. ROCHA M.D.

MEDICARE: DR. BERNARDINO L.V.C.B. ROCHA M.D.
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
1208600000XSurgery PhysicianR72609AZ
22086S0129XVascular Surgery Physician2017030523MO

General Provider Information

NPI Number : 1558658815
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BERNARDINO L.V.C.B. ROCHA M.D.
Provider Business Mailing Address
First Line : PO BOX 258857
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73125-8857
Country : US
Telephone Number : 405-241-3539
Fax Number : 405-241-0998
Provider Business Practice Location Address
First Line : 3200 QUAIL SPRINGS PKWY STE 200
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-2699
Country : US
Telephone Number : 405-241-3539
Fax Number : 405-241-0998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2011
Last Update Date : 08/04/2022

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