Provider Demographics
NPI:1548260052
Name:ROCHA, PATRICIA MAGDALENA (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MAGDALENA
Last Name:ROCHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 E ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-2245
Mailing Address - Country:US
Mailing Address - Phone:505-287-6500
Mailing Address - Fax:505-287-9053
Practice Address - Street 1:1423 E ROOSEVELT AVENUE
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2118
Practice Address - Country:US
Practice Address - Phone:505-287-6500
Practice Address - Fax:505-287-9053
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92197207Q00000X
NMMD2004-0636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A921970Medicaid
NMI23688Medicare UPIN
CAAX608XMedicare PIN
CAAX608WMedicare UPIN
CAAX608YMedicare PIN
CA00A921970Medicaid
CAAX608ZMedicare PIN