MEDICARE: DR. RODERICK ALLAN BACHO PH.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
1	103TC0700X	Clinical Psychologist	0810000234	VA

General Provider Information

NPI Number	:	1932278835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODERICK ALLAN BACHO PH.D.

Provider Business Mailing Address
First Line	:	2080 CHILD ST DEPT 5000
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-0001
Country	:	US
Telephone Number	:	904-270-4335
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 CHILD ST DEPT 5000
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-0001
Country	:	US
Telephone Number	:	904-270-4335
Fax Number	:	808-433-1466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/22/2025

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