Healthcare Provider Details

I. General information

NPI: 1871084376
Provider Name (Legal Business Name): RITA ROA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 DUNDAS ST
LOS ANGELES CA
90063-2610
US

IV. Provider business mailing address

6614 AVENUE U UNIT 789
BROOKLYN NY
11234-6021
US

V. Phone/Fax

Practice location:
  • Phone: 916-612-7829
  • Fax:
Mailing address:
  • Phone: 916-612-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: