Provider Demographics
NPI:1770616716
Name:ROCCO-WELCH, AUDREY KATE (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:KATE
Last Name:ROCCO-WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:KATE
Other - Last Name:ROCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26800 CROWN VALLEY PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8018
Mailing Address - Country:US
Mailing Address - Phone:949-276-2111
Mailing Address - Fax:949-276-2116
Practice Address - Street 1:30300 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1304
Practice Address - Country:US
Practice Address - Phone:949-240-2030
Practice Address - Fax:949-240-5869
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G659980OtherMEDICAL
CA00G65998OtherCALOPTIMA
CAF10742Medicare UPIN