Provider Demographics
NPI:1174346829
Name:ROCHA PENA, CARLOS MAURICIO (MS)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MAURICIO
Last Name:ROCHA PENA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 SW 138TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7165
Mailing Address - Country:US
Mailing Address - Phone:786-271-8932
Mailing Address - Fax:
Practice Address - Street 1:9009 SW 138TH ST APT C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7165
Practice Address - Country:US
Practice Address - Phone:786-271-8932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program