Healthcare Provider Details

I. General information

NPI: 1457778706
Provider Name (Legal Business Name): ROSHAN COORAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

659 W 157TH ST
GARDENA CA
90247-4253
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5700
  • Fax:
Mailing address:
  • Phone: 973-926-7471
  • Fax: 973-926-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA148111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: