Provider Demographics
NPI:1689339558
Name:ROCHA MILLAN, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:ROCHA MILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2233
Mailing Address - Country:US
Mailing Address - Phone:559-685-4601
Mailing Address - Fax:
Practice Address - Street 1:16686 ROAD 168
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9246
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-366-7060
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP3208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics