Provider Demographics
NPI:1194403642
Name:ROCKET DOCTOR PRACTICE GROUP, P.C.
Entity type:Organization
Organization Name:ROCKET DOCTOR PRACTICE GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-648-9032
Mailing Address - Street 1:2219 MAIN ST UNIT 653
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2245
Mailing Address - Country:US
Mailing Address - Phone:310-648-9032
Mailing Address - Fax:
Practice Address - Street 1:20311 SW ACACIA ST STE 140
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1733
Practice Address - Country:US
Practice Address - Phone:310-648-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty