Healthcare Provider Details

I. General information

NPI: 1174099261
Provider Name (Legal Business Name): AJA ROLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19772 MACARTHUR BLVD
IRVINE CA
92612-2413
US

IV. Provider business mailing address

19772 MACARTHUR BLVD STE 260A
IRVINE CA
92612-2413
US

V. Phone/Fax

Practice location:
  • Phone: 949-683-0567
  • Fax:
Mailing address:
  • Phone: 949-474-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number13161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: