Provider Demographics
NPI:1457948382
Name:ROCHA, GUADALUPE (RN)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:ROCHA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 KENDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1301
Mailing Address - Country:US
Mailing Address - Phone:210-712-4803
Mailing Address - Fax:
Practice Address - Street 1:558 KENDALIA AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1301
Practice Address - Country:US
Practice Address - Phone:210-712-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX955572163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics