Basic Information
| Provider Information | |||||||||
| NPI: | 1649731696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROCES | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | JENNIPER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1967 W SUMMERFIELD CT | ||||||||
| Address2: | |||||||||
| City: | OAKLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945613078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158459825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1449 YGNACIO VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945982932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259395820 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2019 | ||||||||
| LastUpdateDate: | 03/30/2019 | ||||||||
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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 | 225200000X | 10744 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.