Healthcare Provider Details

I. General information

NPI: 1457728396
Provider Name (Legal Business Name): ROSHNI NARURKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 02/07/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 CAMPUS STREET CSP-11015
LOMA LINDA CA
92350-2509
US

IV. Provider business mailing address

11175 CAMPUS STREET, CSP-11015
LOMA LINDA CA
92350-1785
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4910
  • Fax:
Mailing address:
  • Phone: 909-558-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35141408
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA173738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: