Provider Demographics
NPI:1417498064
Name:ALTZNER, ROCIO
Entity Type:Individual
Prefix:MRS
First Name:ROCIO
Middle Name:
Last Name:ALTZNER
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 1:680 WICKHAM LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2219
Mailing Address - Country:US
Mailing Address - Phone:321-693-1763
Mailing Address - Fax:
Practice Address - Street 1:680 WICKHAM LAKES DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2219
Practice Address - Country:US
Practice Address - Phone:321-693-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA432-720-63-909-0247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other