Provider Demographics
NPI:1164455051
Name:ROACH, KAREN Z (RNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:Z
Last Name:ROACH
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:ZALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP
Mailing Address - Street 1:3660 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3912
Mailing Address - Country:US
Mailing Address - Phone:951-782-5110
Mailing Address - Fax:951-782-5104
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2615
Practice Address - Country:US
Practice Address - Phone:951-782-3878
Practice Address - Fax:951-784-3268
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16179OtherNURSE PRACTITIONER