Provider Demographics
NPI:1720056609
Name:AROCHA, RUDY WILBERT (OTHER)
Entity Type:Individual
Prefix:MR
First Name:RUDY
Middle Name:WILBERT
Last Name:AROCHA
Suffix:
Gender:M
Credentials:OTHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W JANIN CIR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1414
Mailing Address - Country:US
Mailing Address - Phone:361-776-1107
Mailing Address - Fax:
Practice Address - Street 1:BRANCH HEALTH CLINIC
Practice Address - Street 2:327 CORAL SEA DR. SUITE 165
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362
Practice Address - Country:US
Practice Address - Phone:361-776-1107
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710I1002XOtherINDEPENDENT DUTY CORPSMAN