Provider Demographics
NPI:1598583841
Name:ROCHA, VIVIANA JO
Entity type:Individual
Prefix:
First Name:VIVIANA
Middle Name:JO
Last Name:ROCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E PARMER LN UNIT 1445
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-9760
Mailing Address - Country:US
Mailing Address - Phone:830-255-1159
Mailing Address - Fax:
Practice Address - Street 1:1900 E PARMER LN UNIT 1445
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-9760
Practice Address - Country:US
Practice Address - Phone:830-255-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931874163W00000X
TX1163383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse