Provider Demographics
NPI:1336115427
Name:ISSEROFF, ROSLYN RIVKAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:RIVKAH
Last Name:ISSEROFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3200 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5020
Mailing Address - Country:US
Mailing Address - Phone:916-734-6795
Mailing Address - Fax:916-734-6793
Practice Address - Street 1:3301 C ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3300
Practice Address - Country:US
Practice Address - Phone:916-734-6795
Practice Address - Fax:916-442-5702
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG43459207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49357Medicare UPIN