Healthcare Provider Details

I. General information

NPI: 1205254695
Provider Name (Legal Business Name): ROSHINI YAPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 PACIFIC ST STE D2
MONTEREY CA
93940-2819
US

IV. Provider business mailing address

6182 W LINDA LN
CHANDLER AZ
85226-5844
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-6802
  • Fax:
Mailing address:
  • Phone: 480-875-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number59873
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD21043
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0061341
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number181712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: