Provider Demographics
NPI:1528034113
Name:JAVIER ROCHA
Entity Type:Organization
Organization Name:JAVIER ROCHA
Other - Org Name:SAN MIGUEL MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-994-3904
Mailing Address - Street 1:5407 N MCCOLL RD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2250
Mailing Address - Country:US
Mailing Address - Phone:956-994-3904
Mailing Address - Fax:956-994-3951
Practice Address - Street 1:5407 N MCCOLL RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2250
Practice Address - Country:US
Practice Address - Phone:956-994-3904
Practice Address - Fax:956-994-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0077185332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170305002Medicaid
TX170305001Medicaid
TX170305002Medicaid