Healthcare Provider Details

I. General information

NPI: 1063671386
Provider Name (Legal Business Name): ROXANNE FISCELLA, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MILVIA ST SUITE 116
BERKELEY CA
94704-2636
US

IV. Provider business mailing address

2500 MILVIA ST SUITE 116
BERKELEY CA
94704-2636
US

V. Phone/Fax

Practice location:
  • Phone: 510-843-0692
  • Fax: 510-843-3230
Mailing address:
  • Phone: 510-843-0692
  • Fax: 510-843-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG42958
License Number StateCA

VIII. Authorized Official

Name: DR. ROXANNE CLAIRE FISCELLA
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 510-843-0692