Provider Demographics
NPI:1912517806
Name:SAKUBU-ROTHROCK, GLORIOSE
Entity Type:Individual
Prefix:MRS
First Name:GLORIOSE
Middle Name:
Last Name:SAKUBU-ROTHROCK
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 1:1703 N FIFE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-7509
Mailing Address - Country:US
Mailing Address - Phone:253-973-3460
Mailing Address - Fax:
Practice Address - Street 1:1703 N FIFE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7509
Practice Address - Country:US
Practice Address - Phone:253-973-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter