Provider Demographics
NPI:1205449451
Name:FRIAS, ROCIO (RDA)
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:FRIAS
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 ETIWANDA AVE APT 31207
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8730
Mailing Address - Country:US
Mailing Address - Phone:909-358-9989
Mailing Address - Fax:
Practice Address - Street 1:1160 E ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-8653
Practice Address - Country:US
Practice Address - Phone:951-531-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA63784126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARDA63784Medicaid