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NPI Code Detail

MEDICARE: THOMAS ALBERT ROACH

MEDICARE: THOMAS ALBERT 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
1101YS0200XSchool Counselor240070484CA

General Provider Information

NPI Number : 1386520369
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS ALBERT ROACH
Provider Business Mailing Address
First Line : 2000 OTTERBEIN AVE
Second Line :
City : ROWLAND HGHTS
State : CA
Zip : 91748-3949
Country : US
Telephone Number : 626-965-3448
Fax Number :
Provider Business Practice Location Address
First Line : 2000 OTTERBEIN AVE
Second Line :
City : ROWLAND HGHTS
State : CA
Zip : 91748-3949
Country : US
Telephone Number : 626-965-3448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2025
Last Update Date : 08/14/2025

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Directions to “ THOMAS ALBERT ROACH ” Practice Location

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