Provider Demographics
NPI:1235747189
Name:ROCHA, IZBIETA
Entity type:Individual
Prefix:
First Name:IZBIETA
Middle Name:
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 1:2001 JUNIPERO SERRA BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3888
Mailing Address - Country:US
Mailing Address - Phone:650-991-6200
Mailing Address - Fax:650-746-1620
Practice Address - Street 1:2001 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-3891
Practice Address - Country:US
Practice Address - Phone:650-991-6200
Practice Address - Fax:650-746-1620
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor