Provider Demographics
NPI:1124619143
Name:ROCHA, JOSE III
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:ROCHA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-0591
Mailing Address - Country:US
Mailing Address - Phone:956-472-3043
Mailing Address - Fax:
Practice Address - Street 1:813 S MILE 1 EAST RD
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-7857
Practice Address - Country:US
Practice Address - Phone:956-472-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0203463747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider