Grace Derocha, R.D., C.D.E

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

886178 Issued in MI

Practice address

30158 Trailwood Dr
Warren, MI 48092-6304

Phone

(313) 570-1166

NPI assigned

Sep 24, 2007

Last updated

Oct 21, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Grace Arriola Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382313600000",
    "number": "1659567592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 BREWERY PARK BLVD",
            "address_2": "SUITE 200",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074544",
            "telephone_number": "313-446-4444",
            "fax_number": "313-446-4445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30158 TRAILWOOD DR",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480926304",
            "telephone_number": "313-570-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROCHA",
        "first_name": "GRACE",
        "credential": "R.D., C.D.E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-24",
        "last_updated": "2013-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MI",
            "license": "886178",
            "primary": true
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "MI",
            "license": "20920243",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "ARRIOLA",
            "credential": "R.D., C.D.E.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Dietitian in Warren, MI
• Providers in Warren, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.