Healthcare Provider Details

I. General information

NPI: 1538523873
Provider Name (Legal Business Name): INGA ROIZMAN RADT-II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 MAGNOLIA BLVD
VALLEY VILLAGE CA
91607-2415
US

IV. Provider business mailing address

12439 MAGNOLIA BLVD #613
VALLEY VILLAGE CA
91607-2450
US

V. Phone/Fax

Practice location:
  • Phone: 818-495-4300
  • Fax:
Mailing address:
  • Phone: 310-367-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: