Basic Information
| Provider Information | |||||||||
| NPI: | 1134562754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROCHA | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | ERACLIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126249990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 DELAWARE ST SE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126249990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2013 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 65470 | MN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD2016-0966 | NM | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 55498 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.