Provider Demographics
NPI:1497916365
Name:ROGGE, JEANETTE VIALL (LAC, MSOM)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:VIALL
Last Name:ROGGE
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26619 CARMEL CENTER PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8656
Mailing Address - Country:US
Mailing Address - Phone:831-625-6161
Mailing Address - Fax:831-625-0170
Practice Address - Street 1:26619 CARMEL CENTER PL
Practice Address - Street 2:SUITE 201
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8656
Practice Address - Country:US
Practice Address - Phone:831-625-6161
Practice Address - Fax:831-625-0170
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9472171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist