Provider Demographics
NPI:1730689407
Name:ROCHA, JULIE (LVN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ROCHA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11961 MESQUITE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3151
Mailing Address - Country:US
Mailing Address - Phone:915-540-8667
Mailing Address - Fax:
Practice Address - Street 1:11961 MESQUITE ROCK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3151
Practice Address - Country:US
Practice Address - Phone:915-540-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334274164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse