Provider Demographics
NPI:1700125572
Name:BAENA, ROCIO MORA (R EEG, CNIM)
Entity Type:Individual
Prefix:MRS
First Name:ROCIO
Middle Name:MORA
Last Name:BAENA
Suffix:
Gender:F
Credentials:R EEG, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 N ANGELENO AVE
Mailing Address - Street 2:PO BOX 911
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1913
Mailing Address - Country:US
Mailing Address - Phone:626-224-1287
Mailing Address - Fax:
Practice Address - Street 1:1108 N ANGELENO AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-1913
Practice Address - Country:US
Practice Address - Phone:626-224-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349 AND 2565246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic