Provider Demographics
NPI:1740295138
Name:ROCCO, ROBERT P (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:ROCCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1870
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95077-1870
Mailing Address - Country:US
Mailing Address - Phone:831-728-8250
Mailing Address - Fax:831-707-2777
Practice Address - Street 1:901 SUNSET DR
Practice Address - Street 2:SUITE 1
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5613
Practice Address - Country:US
Practice Address - Phone:831-637-1655
Practice Address - Fax:831-637-6894
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA26562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A265620Medicaid
CA00A265620Medicare ID - Type Unspecified
CA00A265620Medicaid