Provider Demographics
NPI:1336340926
Name:ROCK, CONSTANCE JEAN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:JEAN
Last Name:ROCK
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4859 OLD REDWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1415
Mailing Address - Country:US
Mailing Address - Phone:707-387-2088
Mailing Address - Fax:707-324-5582
Practice Address - Street 1:19920 NICHOLAS WAY
Practice Address - Street 2:
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457-9162
Practice Address - Country:US
Practice Address - Phone:818-324-2678
Practice Address - Fax:636-334-2631
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA117176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife