Provider Demographics
NPI:1518938687
Name:ROCHA, SANDRA (DO)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ROCHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E REDD RD
Mailing Address - Street 2:BLDG 4
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7265
Mailing Address - Country:US
Mailing Address - Phone:915-577-9003
Mailing Address - Fax:915-577-9020
Practice Address - Street 1:840 E REDD RD
Practice Address - Street 2:BLDG 4
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7221
Practice Address - Country:US
Practice Address - Phone:915-577-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162118702Medicaid
TXH74604Medicare UPIN
TX8B1478Medicare PIN