Provider Demographics
NPI:1801173158
Name:ROCAMORA, JOANNE FAYE CACATIAN
Entity type:Individual
Prefix:
First Name:JOANNE FAYE
Middle Name:CACATIAN
Last Name:ROCAMORA
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 1:1432 FRY LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2536
Mailing Address - Country:US
Mailing Address - Phone:510-331-5104
Mailing Address - Fax:
Practice Address - Street 1:1432 FRY LANE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545
Practice Address - Country:US
Practice Address - Phone:510-331-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist