Healthcare Provider Details

I. General information

NPI: 1801468012
Provider Name (Legal Business Name): ROULA CREIGHTON MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19200 VON KARMAN AVE STE 350
IRVINE CA
92612-8509
US

IV. Provider business mailing address

19200 VON KARMAN AVE STE 350
IRVINE CA
92612-8509
US

V. Phone/Fax

Practice location:
  • Phone: 949-202-7566
  • Fax: 949-437-3428
Mailing address:
  • Phone: 949-202-7566
  • Fax: 949-437-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROULA CREIGHTON
Title or Position: PRESIDENY
Credential: MD
Phone: 949-202-7566