Provider Demographics
NPI:1194755918
Name:ROCHE, NIALL E
Entity type:Individual
Prefix:
First Name:NIALL
Middle Name:E
Last Name:ROCHE
Suffix:
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 1:5565 W LAS POSITAS BLVD
Mailing Address - Street 2:STE 310
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4001
Mailing Address - Country:US
Mailing Address - Phone:925-924-9100
Mailing Address - Fax:925-924-9102
Practice Address - Street 1:5565 W LAS POSITAS BLVD
Practice Address - Street 2:STE 310
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4001
Practice Address - Country:US
Practice Address - Phone:925-924-9100
Practice Address - Fax:925-924-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF77177Medicare UPIN