Basic Information
| Provider Information | |||||||||
| NPI: | 1841427564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROCA | ||||||||
| FirstName: | MEL | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 642117 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681648117 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2201 W BROADWAY | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515013605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123289100 | ||||||||
| FaxNumber: | 7123280095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2009 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A108140 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 38891 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.