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General NPI Number Information
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NPI Number | 1700437241
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Entity Type | Individual
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Provider Name | MICHELLE ROXAS TRAN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 18370 BURBANK BLVD
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City | TARZANA
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State | CA
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Zip | 91356-2804
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Country | US
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Telephone | 818-578-7167
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1598
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City | CYPRESS
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State | CA
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Zip | 90630-6598
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Country | US
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Telephone | 714-331-6557
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95012356
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License Number State | CA
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