Provider Demographics
NPI:1639819402
Name:CONCA, ROCCO CARL
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:CARL
Last Name:CONCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 NW COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2411
Mailing Address - Country:US
Mailing Address - Phone:303-815-2125
Mailing Address - Fax:
Practice Address - Street 1:852 NW COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2411
Practice Address - Country:US
Practice Address - Phone:303-815-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program