Provider Demographics
NPI:1750193421
Name:ROCHA, KATTIE ILENE
Entity type:Individual
Prefix:
First Name:KATTIE
Middle Name:ILENE
Last Name:ROCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81746 OLEA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3077
Mailing Address - Country:US
Mailing Address - Phone:760-899-2268
Mailing Address - Fax:
Practice Address - Street 1:78370 HIGHWAY 111 STE 260
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2623
Practice Address - Country:US
Practice Address - Phone:800-939-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician