Provider Demographics
NPI:1932240173
Name:WARD, FREDERICK ROCH
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:ROCH
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 FALLSVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-0912
Mailing Address - Country:US
Mailing Address - Phone:760-798-4881
Mailing Address - Fax:
Practice Address - Street 1:5814 VAN ALLEN WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7358
Practice Address - Country:US
Practice Address - Phone:760-438-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist