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General NPI Number Information
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NPI Number | 1164701819
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Entity Type | Individual
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Provider Name | ROKHSAREH ROXANNE TAJRISHI M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 3334 E COAST HWY SUITE 570
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2328
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Country | US
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Telephone | 714-903-7767
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Fax | 714-903-7801
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Provider Business Mailing Address
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Address Line | 3334 E COAST HWY SUITE 570
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2328
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Country | US
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Telephone | 714-903-7767
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Fax | 714-903-7801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | A133047
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License Number State | CA
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