Basic Information
Provider Information | |||||||||
NPI: | 1912088048 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NORONHA | ||||||||
FirstName: | ROHINI | ||||||||
MiddleName: | ERIKA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3687 MT DIABLO BLVD STE 200 | ||||||||
Address2: |   | ||||||||
City: | LAFAYETTE | ||||||||
State: | CA | ||||||||
PostalCode: | 945493746 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9168546975 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2450 ASHBY AVE RM 5505 | ||||||||
Address2: |   | ||||||||
City: | BERKELEY | ||||||||
State: | CA | ||||||||
PostalCode: | 947052067 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5102044444 | ||||||||
FaxNumber: | 5106498287 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/17/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-116701 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | C55277 | CA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 036116181 | 01 | IL | BCBS | OTHER | 036116701 | 01 | IL | BCBS | OTHER | 036116701 | 05 | IL |   | MEDICAID | P00356270 | 01 | IL | RR MEDICARE | OTHER | C55277 | 01 | CA | STATE LICENSE | OTHER | P00356269 | 01 | IL | RAIL ROAD MEDICARE | OTHER |