MEDICARE: DEZARAY ROEBUCK

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	106H00000X	Marriage & Family Therapist	1234	CA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1447779137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEZARAY ROEBUCK

Provider Business Mailing Address
First Line	:	2116 ARLINGTON AVE STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1353
Country	:	US
Telephone Number	:	323-737-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 ARLINGTON AVE STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1353
Country	:	US
Telephone Number	:	323-737-3900
Fax Number	:

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	04/17/2026

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Directions to “ DEZARAY ROEBUCK ” Practice Location

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