Provider Demographics
NPI:1205308129
Name:ROCHA, DIANNA ELIZABETH (DC)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:ELIZABETH
Last Name:ROCHA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 MISSION BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-8076
Mailing Address - Country:US
Mailing Address - Phone:619-630-7343
Mailing Address - Fax:
Practice Address - Street 1:2999 MISSION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-8076
Practice Address - Country:US
Practice Address - Phone:619-630-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34372111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician