Provider Demographics
NPI:1851321939
Name:DE LA ROCHA, QUENBY THRINE (PA)
Entity Type:Individual
Prefix:
First Name:QUENBY
Middle Name:THRINE
Last Name:DE LA ROCHA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:QUENBY
Other - Middle Name:THRINE
Other - Last Name:HARLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:168 N BRENT ST STE 506
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2840
Practice Address - Country:US
Practice Address - Phone:805-652-6373
Practice Address - Fax:805-648-1470
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ36040Medicare UPIN
CAW268Medicare PIN
CAWPA17491AMedicare ID - Type Unspecified
CA0878110001Medicare NSC
CAW268AMedicare PIN