Provider Demographics
NPI:1104204346
Name:ROCHA, TRINIDAD CARLOS (RDA)
Entity Type:Individual
Prefix:MR
First Name:TRINIDAD
Middle Name:CARLOS
Last Name:ROCHA
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E HUNTINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3750
Mailing Address - Country:US
Mailing Address - Phone:626-447-5126
Mailing Address - Fax:
Practice Address - Street 1:440 E HUNTINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3750
Practice Address - Country:US
Practice Address - Phone:626-447-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61135126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant