Provider Demographics
NPI:1215732011
Name:ROCHA, ALEXIS N (RD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:N
Last Name:ROCHA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:N
Other - Last Name:LONGENECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:245 NE 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-9502
Mailing Address - Country:US
Mailing Address - Phone:541-310-1914
Mailing Address - Fax:
Practice Address - Street 1:1241 SE BAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4227
Practice Address - Country:US
Practice Address - Phone:541-310-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10217272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered