Provider Demographics
NPI:1821343757
Name:ROCHA, JENNIFER ARLENE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ARLENE
Last Name:ROCHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ARLENE
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5920 WEST MALL
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4232
Mailing Address - Country:US
Mailing Address - Phone:805-466-0676
Mailing Address - Fax:805-466-4862
Practice Address - Street 1:5920 WEST MALL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4232
Practice Address - Country:US
Practice Address - Phone:805-466-0676
Practice Address - Fax:805-466-4862
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA22367OtherCALIFORNIA STATE LICENSE
1104509OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS