Provider Demographics
NPI:1508055161
Name:JUAN L ROCHA DPM
Entity Type:Organization
Organization Name:JUAN L ROCHA DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-986-0704
Mailing Address - Street 1:PO BOX 4007
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4007
Mailing Address - Country:US
Mailing Address - Phone:956-554-3010
Mailing Address - Fax:956-986-2624
Practice Address - Street 1:110 PLAZA SANTA ROSA
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9785
Practice Address - Country:US
Practice Address - Phone:956-554-3010
Practice Address - Fax:956-986-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1747213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180508701Medicaid
TX180508701Medicaid
TX00477ZMedicare PIN