Provider Demographics
NPI:1902902109
Name:ROCHEL-SURES, MICHELINE M (MSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELINE
Middle Name:M
Last Name:ROCHEL-SURES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 FERN ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-1515
Mailing Address - Country:US
Mailing Address - Phone:760-294-0061
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DRIVE
Practice Address - Street 2:MAILCODE 122
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161
Practice Address - Country:US
Practice Address - Phone:858-642-1404
Practice Address - Fax:858-552-7455
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000055451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical