Provider Demographics
NPI:1528076098
Name:DEROCK, BERNARD LAWSON (RN,CADC)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:LAWSON
Last Name:DEROCK
Suffix:
Gender:M
Credentials:RN,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9444 HARBOUR POINT DR
Mailing Address - Street 2:198
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3714
Mailing Address - Country:US
Mailing Address - Phone:530-867-5648
Mailing Address - Fax:
Practice Address - Street 1:651 I ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2400
Practice Address - Country:US
Practice Address - Phone:916-874-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse