Basic Information
| Provider Information | |||||||||
| NPI: | 1629197785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARREN | ||||||||
| FirstName: | ROXANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45420 17TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935341309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619471595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1609 E PALMDALE BLVD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935504881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9919471595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.