Provider Demographics
NPI:1689921405
Name:ROCHA, MARCO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:ROCHA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 SUNSET DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4529
Mailing Address - Country:US
Mailing Address - Phone:305-661-7601
Mailing Address - Fax:305-661-0154
Practice Address - Street 1:6701 SUNSET DR STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4529
Practice Address - Country:US
Practice Address - Phone:305-661-7601
Practice Address - Fax:305-661-0154
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106606363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant