MEDICARE: THOMAS ALBERT ROACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor	240070484	CA

General Provider Information

NPI Number	:	1386520369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS ALBERT ROACH

Provider Business Mailing Address
First Line	:	2000 OTTERBEIN AVE
Second Line	:
City	:	ROWLAND HGHTS
State	:	CA
Zip	:	91748-3949
Country	:	US
Telephone Number	:	626-965-3448
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 OTTERBEIN AVE
Second Line	:
City	:	ROWLAND HGHTS
State	:	CA
Zip	:	91748-3949
Country	:	US
Telephone Number	:	626-965-3448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2025
Last Update Date	:	08/14/2025

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Directions to “ THOMAS ALBERT ROACH ” Practice Location

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