Provider Demographics
NPI:1497877138
Name:ROCHELLE, NINA VICTORIA (PA)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:VICTORIA
Last Name:ROCHELLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1933 S OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1520
Mailing Address - Country:US
Mailing Address - Phone:323-731-9744
Mailing Address - Fax:323-731-9744
Practice Address - Street 1:3130 S HILL ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3817
Practice Address - Country:US
Practice Address - Phone:213-747-7267
Practice Address - Fax:213-747-4835
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 11485363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical