Provider Demographics
NPI:1356837314
Name:ROCA, GERSON (LPN)
Entity Type:Individual
Prefix:
First Name:GERSON
Middle Name:
Last Name:ROCA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 NICHOLS ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4968
Mailing Address - Country:US
Mailing Address - Phone:508-361-5071
Mailing Address - Fax:
Practice Address - Street 1:391 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3470
Practice Address - Country:US
Practice Address - Phone:617-394-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN67483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse