Provider Demographics
NPI:1033515507
Name:ROCHA, SUSANA TERESA (LVN)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:TERESA
Last Name:ROCHA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 JANET DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1064
Mailing Address - Country:US
Mailing Address - Phone:559-239-7290
Mailing Address - Fax:
Practice Address - Street 1:1405 JANET DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1064
Practice Address - Country:US
Practice Address - Phone:559-239-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN127140164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse