Provider Demographics
NPI:1124037635
Name:ROESLER, JOHN MARTIN (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARTIN
Last Name:ROESLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24025 PARK SORRENTO
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302
Mailing Address - Country:US
Mailing Address - Phone:818-609-7200
Mailing Address - Fax:855-754-3775
Practice Address - Street 1:24025 PARK SORRENTO
Practice Address - Street 2:SUITE 405
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302
Practice Address - Country:US
Practice Address - Phone:818-609-7200
Practice Address - Fax:855-754-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72319174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA201118042OtherTAX ID
A72319Medicare ID - Type Unspecified
CA201118042OtherTAX ID