Basic Information
| Provider Information | |||||||||
| NPI: | 1639258353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROCCO | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 E PRICE RD BLDG F | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785213531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565046080 | ||||||||
| FaxNumber: | 9565046419 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 E PRICE RD BLDG F | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785213531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565046080 | ||||||||
| FaxNumber: | 9565046419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 03/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G3738 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 137218710 | 01 | TX | MEDICAID EPSDT | OTHER | 137218707 | 05 | TX | MEDICAID |