Provider Demographics
NPI:1831358027
Name:DAVID F LA ROCHELLE MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:DAVID F LA ROCHELLE MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:LA ROCHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-427-5020
Mailing Address - Street 1:1261 TRAVIS BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4897
Mailing Address - Country:US
Mailing Address - Phone:707-427-5020
Mailing Address - Fax:707-427-5023
Practice Address - Street 1:1261 TRAVIS BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4897
Practice Address - Country:US
Practice Address - Phone:707-427-5020
Practice Address - Fax:707-427-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC 38056207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36830Medicare UPIN