Provider Demographics
NPI:1164857959
Name:ROCHA, LADONNA (BCDNM, LSA)
Entity Type:Individual
Prefix:MRS
First Name:LADONNA
Middle Name:
Last Name:ROCHA
Suffix:
Gender:F
Credentials:BCDNM, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 S STAPLES ST STE 401
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2952
Mailing Address - Country:US
Mailing Address - Phone:361-902-8899
Mailing Address - Fax:
Practice Address - Street 1:6000 S STAPLES ST STE 401
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2952
Practice Address - Country:US
Practice Address - Phone:361-902-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X, 246ZC0007X
TXSA00853363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No175F00000XOther Service ProvidersNaturopath
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145270OtherNBSTSA