Healthcare Provider Details

I. General information

NPI: 1831388206
Provider Name (Legal Business Name): ROOBA WARDEH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

3514 PATRICIA ST
WEST COVINA CA
91792-2606
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number94448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: