Basic Information
| Provider Information | |||||||||
| NPI: | 1063671386 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROXANNE FISCELLA, M.D. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 MILVIA ST | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947042636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108430692 | ||||||||
| FaxNumber: | 5108433230 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 MILVIA ST | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947042636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108430692 | ||||||||
| FaxNumber: | 5108433230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 06/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | FISCELLA | ||||||||
| AuthorizedOfficialFirstName: | ROXANNE | ||||||||
| AuthorizedOfficialMiddleName: | CLAIRE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 5108430692 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | G42958 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Legal Medicine |
No ID Information.