Provider Demographics
NPI:1841447893
Name:ROCHA, HEATHER ANN (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:ROCHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3451
Mailing Address - Street 2:
Mailing Address - City:WAQUOIT
Mailing Address - State:MA
Mailing Address - Zip Code:02536-3451
Mailing Address - Country:US
Mailing Address - Phone:650-814-4143
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:ROOM 3554
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-814-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21990227900000X
VA0117005308227900000X
MA2594363A00000X
CA19842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered