Provider Demographics
NPI:1083894075
Name:ROCCO, GOWRI REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:GOWRI
Middle Name:REDDY
Last Name:ROCCO
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 1:1643 ZURITA CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8809
Mailing Address - Country:US
Mailing Address - Phone:951-808-0171
Mailing Address - Fax:
Practice Address - Street 1:11705 SLATE AVE STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-5199
Practice Address - Country:US
Practice Address - Phone:949-375-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI22572Medicare UPIN
NJ086376Medicare PIN