Provider Demographics
NPI:1942599600
Name:MARTIN ROCHA MD INC
Entity Type:Organization
Organization Name:MARTIN ROCHA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:909-659-2850
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:CEDAR GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:92321-0716
Mailing Address - Country:US
Mailing Address - Phone:909-336-3670
Mailing Address - Fax:909-336-3674
Practice Address - Street 1:251 N HIGHWAY 173, SUITE 6
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92321-0716
Practice Address - Country:US
Practice Address - Phone:909-336-3670
Practice Address - Fax:909-336-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty