Provider Demographics
NPI:1023215779
Name:ROCHE, OLGA BOICAN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:BOICAN
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711045 CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96127-0003
Mailing Address - Country:US
Mailing Address - Phone:530-251-6574
Mailing Address - Fax:
Practice Address - Street 1:711-045 CENTER ROAD
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96127-0003
Practice Address - Country:US
Practice Address - Phone:530-257-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78012207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine