Healthcare Provider Details

I. General information

NPI: 1831966456
Provider Name (Legal Business Name): ONEIL ROLANDO PEART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 BLOOMFIELD AVE
SANTA FE SPRINGS CA
90670-4601
US

IV. Provider business mailing address

12501 IMPERIAL HWY STE 500-B
NORWALK CA
90650-3179
US

V. Phone/Fax

Practice location:
  • Phone: 562-906-2676
  • Fax:
Mailing address:
  • Phone: 562-784-2972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: