Provider Demographics
NPI:1639173107
Name:ROCHA FAROOQ, MARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:
Last Name:ROCHA FAROOQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2016
Mailing Address - Country:US
Mailing Address - Phone:562-595-6050
Mailing Address - Fax:562-595-6099
Practice Address - Street 1:4300 LONG BEACH BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2011
Practice Address - Country:US
Practice Address - Phone:562-595-6050
Practice Address - Fax:562-595-6099
Is Sole Proprietor?:No
Enumeration Date:2005-06-12
Last Update Date:2009-08-12
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CAA53701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537010Medicaid
CA00A537010Medicaid