MEDICARE: DRE'SHON J ROLLE

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
1	246RM2200X	Medical Laboratory Technician

General Provider Information

NPI Number	:	1780284372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DRE'SHON J ROLLE

Provider Business Mailing Address
First Line	:	28601 LOS ALISOS BLVD APT 1054
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-7909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28601 LOS ALISOS BLVD APT 1054
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92692-7909
Country	:	US
Telephone Number	:	602-350-9515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2020
Last Update Date	:	10/31/2020

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Directions to “ DRE'SHON J ROLLE ” Practice Location

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