MEDICARE: ROSHNI PATEL

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1831821875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSHNI PATEL

Provider Business Mailing Address
First Line	:	550 E DEVON AVE STE 110
Second Line	:
City	:	ITASCA
State	:	IL
Zip	:	60143-2637
Country	:	US
Telephone Number	:	847-370-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1123 N ALEXANDRIA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1407
Country	:	US
Telephone Number	:	847-370-6328
Fax Number	:

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

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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Directions to “ ROSHNI PATEL ” Practice Location

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