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NPI Code Detail

MEDICARE: LAURIE DIANE ROACH

MEDICARE: LAURIE DIANE ROACH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1295941953
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE DIANE ROACH
Provider Business Mailing Address
First Line : 1245 W PALM AVE
Second Line :
City : REDLANDS
State : CA
Zip : 92373-5770
Country : US
Telephone Number : 909-798-6164
Fax Number :
Provider Business Practice Location Address
First Line : 34324 YUCAIPA BLVD STE B-D
Second Line :
City : YUCAIPA
State : CA
Zip : 92399-2496
Country : US
Telephone Number : 909-790-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 08/06/2009

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Directions to “ LAURIE DIANE ROACH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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