Provider Demographics
NPI:1932826294
Name:ROCHA-RAZURI, CARMEN
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:ROCHA-RAZURI
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 1:3070 CAMINO GRACIOSA
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4547
Mailing Address - Country:US
Mailing Address - Phone:805-885-7933
Mailing Address - Fax:
Practice Address - Street 1:3070 CAMINO GRACIOSA
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4547
Practice Address - Country:US
Practice Address - Phone:805-885-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical