Healthcare Provider Details

I. General information

NPI: 1780149393
Provider Name (Legal Business Name): ROLAKE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 213TH ST STE 100
TORRANCE CA
90501-2852
US

IV. Provider business mailing address

488 E OCEAN BLVD UNIT 1105
LONG BEACH CA
90802-4776
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-0276
  • Fax:
Mailing address:
  • Phone: 562-907-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number34190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: