Healthcare Provider Details

I. General information

NPI: 1164695409
Provider Name (Legal Business Name): JENNIFER JANE ROELANDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BASTANCHURY RD STE 140
FULLERTON CA
92835-3427
US

IV. Provider business mailing address

1830 CALLE DON GUILLERMO
LA HABRA CA
90631-7616
US

V. Phone/Fax

Practice location:
  • Phone: 714-272-3477
  • Fax:
Mailing address:
  • Phone: 573-355-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2008013765
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC169555
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC169554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: