Healthcare Provider Details

I. General information

NPI: 1316250525
Provider Name (Legal Business Name): ROODABEH MICHELLE KOOLAEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIRMOUNT AVE STE 210
PASADENA CA
91105-3152
US

IV. Provider business mailing address

833 PARKMAN DR
LA CANADA CA
91011-2547
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-4274
  • Fax: 833-438-1648
Mailing address:
  • Phone: 301-602-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS015491
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A12722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: