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General NPI Number Information
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NPI Number | 1689776569
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Entity Type | Organization
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Legal Business Name | RICHMOND E ROESKE A PROFESSIONAL CORP
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 41877 ENTERPRISE CIR N STE 110
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City | TEMECULA
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State | CA
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Zip | 92590-5656
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Country | US
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Telephone | 951-296-2244
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Fax | 951-296-3602
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Provider Business Mailing Address
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Address Line | 41877 ENTERPRISE CIR N STE 110
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City | TEMECULA
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State | CA
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Zip | 92590-5656
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Country | US
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Telephone | 951-296-2244
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Fax | 951-296-3602
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Authorized Official
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Title or Position | PRES
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Name | RICHMOND E ROESKE
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Credential | MD
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Telephone | 951-296-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A64048
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License Number State | CA
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