Provider Demographics
NPI:1720116288
Name:ROCHA, OSCAR M
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:M
Last Name:ROCHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W CAMINO RIO CEBOLLA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8838
Mailing Address - Country:US
Mailing Address - Phone:520-287-0800
Mailing Address - Fax:520-287-0816
Practice Address - Street 1:310 W PLUM ST
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2613
Practice Address - Country:US
Practice Address - Phone:520-287-0800
Practice Address - Fax:520-287-0816
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL4288251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)