Provider Demographics
NPI:1326468331
Name:EDWARDS, ROCHELLA
Entity Type:Individual
Prefix:
First Name:ROCHELLA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 W HOBSONWAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1423
Mailing Address - Country:US
Mailing Address - Phone:760-921-5000
Mailing Address - Fax:760-921-5002
Practice Address - Street 1:1297 W HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1423
Practice Address - Country:US
Practice Address - Phone:760-921-5000
Practice Address - Fax:760-921-5002
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-BROJEF175T00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker