Provider Demographics
NPI:1548269335
Name:ROCHA, GUILLERMO I (MD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:I
Last Name:ROCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GUILLERMO
Other - Middle Name:I
Other - Last Name:ROCHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:517 SW MILITARY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1639
Mailing Address - Country:US
Mailing Address - Phone:210-921-0322
Mailing Address - Fax:210-921-1451
Practice Address - Street 1:517 SW MILITARY DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1639
Practice Address - Country:US
Practice Address - Phone:210-921-0322
Practice Address - Fax:210-921-1451
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2024-09-16
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXG6382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120476001Medicaid
TX00FH94Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER