Provider Demographics
NPI:1609420470
Name:ROCHA, MATTHEW JOSEPH CEZAR (CPHT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH CEZAR
Last Name:ROCHA
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11999 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4272
Mailing Address - Country:US
Mailing Address - Phone:214-872-1515
Mailing Address - Fax:214-872-1516
Practice Address - Street 1:11999 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4272
Practice Address - Country:US
Practice Address - Phone:214-872-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225638183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician