Provider Demographics
NPI:1104013192
Name:FOSTER, ROCHAUNDA (LVN)
Entity Type:Individual
Prefix:
First Name:ROCHAUNDA
Middle Name:
Last Name:FOSTER
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 1:1743 E FAIRFIELD CT
Mailing Address - Street 2:UNIT 1
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-6384
Mailing Address - Country:US
Mailing Address - Phone:909-724-9926
Mailing Address - Fax:
Practice Address - Street 1:1743 E FAIRFIELD CT
Practice Address - Street 2:UNIT 1
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-6384
Practice Address - Country:US
Practice Address - Phone:909-724-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN203294164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN003700OtherMEDI-CAL PROVIDER NUMBER