Provider Demographics
NPI:1962213033
Name:ROCHA, ANDREA GRAIEB SARNO
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:GRAIEB SARNO
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 1:7025 CROZET AVE
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-5071
Mailing Address - Country:US
Mailing Address - Phone:805-587-6624
Mailing Address - Fax:
Practice Address - Street 1:7025 CROZET AVE
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-5071
Practice Address - Country:US
Practice Address - Phone:805-587-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95033320363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner