Healthcare Provider Details

I. General information

NPI: 1497924096
Provider Name (Legal Business Name): ROSHAN REPORTER MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N FIGUEROA ST ROOM 212
LOS ANGELES CA
90012-2602
US

IV. Provider business mailing address

313 N FIGUEROA ST ROOM 212
LOS ANGELES CA
90012-2602
US

V. Phone/Fax

Practice location:
  • Phone: 213-240-7941
  • Fax: 213-482-4856
Mailing address:
  • Phone: 213-240-7941
  • Fax: 213-482-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberG61330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: