Basic Information
| Provider Information | |||||||||
| NPI: | 1821298308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | ROSHNI | ||||||||
| MiddleName: | DINESH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 N PLACENTIA AVE | ||||||||
| Address2: | |||||||||
| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928702332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142237000 | ||||||||
| FaxNumber: | 7142237001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 N PLACENTIA AVE | ||||||||
| Address2: | |||||||||
| City: | PLACENTIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928702332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142237000 | ||||||||
| FaxNumber: | 7142237001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | PA 19239 | CA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | PA 19239 | 01 | CA | LICENSE | OTHER |