Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A78012 | CA |
NPI | 1023215779 |
---|---|
Provider Name | Dr. Olga Boican Roche |
First Address | Susanville, CA 96127-0003 |
Second Address | Susanville, CA 96127-0003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 20/07/2007 |