Provider Demographics
NPI:1063876340
Name:ROCA MEDICAL CENTER
Entity type:Organization
Organization Name:ROCA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RONCALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-373-3766
Mailing Address - Street 1:4500 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6102
Mailing Address - Country:US
Mailing Address - Phone:915-373-3766
Mailing Address - Fax:915-532-9006
Practice Address - Street 1:10393 LEAGUE LINE RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1028
Practice Address - Country:US
Practice Address - Phone:915-373-3766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty