Provider Demographics
NPI:1275331753
Name:ROCHA, JOHN MANUEL JR (RN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MANUEL
Last Name:ROCHA
Suffix:JR
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067-1906
Mailing Address - Country:US
Mailing Address - Phone:719-468-3378
Mailing Address - Fax:
Practice Address - Street 1:900 S 12TH ST
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-2128
Practice Address - Country:US
Practice Address - Phone:719-254-3314
Practice Address - Fax:719-254-3078
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1687988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse