Healthcare Provider Details

I. General information

NPI: 1992847263
Provider Name (Legal Business Name): ROULA SOUFI ADJAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROULA AL-SOUFI M.D.

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/08/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 CARDINAL CT STE 370
SAN DIEGO CA
92123-3332
US

IV. Provider business mailing address

10785 CALLE MAR DE MARIPOSA
SAN DIEGO CA
92130-8656
US

V. Phone/Fax

Practice location:
  • Phone: 619-865-6479
  • Fax:
Mailing address:
  • Phone: 619-865-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA81682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: