Provider Demographics
NPI:1033951660
Name:DEROCCO HEALTH AND WELLNESS INC
Entity type:Organization
Organization Name:DEROCCO HEALTH AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DEROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-504-2434
Mailing Address - Street 1:4200A TECHNOLOGY CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1214
Mailing Address - Country:US
Mailing Address - Phone:620-504-2434
Mailing Address - Fax:
Practice Address - Street 1:4200A TECHNOLOGY CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1214
Practice Address - Country:US
Practice Address - Phone:620-504-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing