MEDICARE: INGA ROIZMAN RADT-II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1538523873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGA ROIZMAN RADT-II

Provider Business Mailing Address
First Line	:	12439 MAGNOLIA BLVD
Second Line	:	#613
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2450
Country	:	US
Telephone Number	:	310-367-9737
Fax Number	:

Provider Business Practice Location Address
First Line	:	12400 MAGNOLIA BLVD
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2415
Country	:	US
Telephone Number	:	818-495-4300
Fax Number	:

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

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	03/22/2017

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