Provider Demographics
NPI:1275059131
Name:ROCHA, ANA MARICELA (NP)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:MARICELA
Last Name:ROCHA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2303
Mailing Address - Country:US
Mailing Address - Phone:310-829-8621
Mailing Address - Fax:310-829-8914
Practice Address - Street 1:12414 EXPOSITION BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1016
Practice Address - Country:US
Practice Address - Phone:310-272-7640
Practice Address - Fax:310-272-7656
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95007168363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care