Healthcare Provider Details

I. General information

NPI: 1437232386
Provider Name (Legal Business Name): MRS. LA TONYA DENICE ROEBUCK-TOWNSEND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 WILSHIRE BLVD
LOS ANGELES CA
90010-1205
US

IV. Provider business mailing address

17780 FAIRVIEW DR
FONTANA CA
92336-2864
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-4603
  • Fax: 213-381-8391
Mailing address:
  • Phone: 900-350-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: