Provider Demographics
NPI:1124143953
Name:ROCABO, CONNIE HORCA (DMD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:HORCA
Last Name:ROCABO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CUNEGUNDA
Other - Middle Name:HORCA
Other - Last Name:ROCABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2489 MISSION ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2400
Mailing Address - Country:US
Mailing Address - Phone:415-641-7739
Mailing Address - Fax:415-641-7752
Practice Address - Street 1:2489 MISSION ST STE 6
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2400
Practice Address - Country:US
Practice Address - Phone:415-641-7739
Practice Address - Fax:415-641-7752
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice