Provider Demographics
NPI:1619764032
Name:ROCCHIO, LEE JAY (N/A)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:JAY
Last Name:ROCCHIO
Suffix:
Gender:
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6270
Mailing Address - Country:US
Mailing Address - Phone:707-703-8370
Mailing Address - Fax:
Practice Address - Street 1:301 6TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6270
Practice Address - Country:US
Practice Address - Phone:707-703-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker