MEDICARE: ROQUELL LANEY MD, MPH

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	207Q00000X	Family Medicine Physician	A173696	CA

General Provider Information

NPI Number	:	1518450675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROQUELL LANEY MD, MPH

Provider Business Mailing Address
First Line	:	3620 4TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-4205
Country	:	US
Telephone Number	:	323-440-9357
Fax Number	:

Provider Business Practice Location Address
First Line	:	741 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4021
Country	:	US
Telephone Number	:	213-413-6666
Fax Number	:

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	08/31/2022

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