Provider Demographics
NPI:1427837061
Name:ROCKER ENERGETICS, INC.
Entity type:Organization
Organization Name:ROCKER ENERGETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DHANELL
Authorized Official - Middle Name:AZADA
Authorized Official - Last Name:ROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-504-1343
Mailing Address - Street 1:6475 E PACIFIC COAST HWY # 278
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4201
Mailing Address - Country:US
Mailing Address - Phone:714-504-1343
Mailing Address - Fax:
Practice Address - Street 1:1500 PACIFIC COAST HWY STE A
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6246
Practice Address - Country:US
Practice Address - Phone:562-431-7193
Practice Address - Fax:562-200-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center