Healthcare Provider Details

I. General information

NPI: 1144174186
Provider Name (Legal Business Name): ADRIANNA MONIQUE ROLDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 WILSHIRE BLVD STE 900
LOS ANGELES CA
90017-2905
US

IV. Provider business mailing address

3680 WILSHIRE BLVD STE P041096
LOS ANGELES CA
90010-2707
US

V. Phone/Fax

Practice location:
  • Phone: 213-531-0291
  • Fax: 213-531-0291
Mailing address:
  • Phone: 213-531-0291
  • Fax: 213-531-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: