Provider Demographics
NPI:1407159916
Name:ROLDAN, TIANYA DANISE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:TIANYA
Middle Name:DANISE
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40700 CALIFORNIA OAKS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5789
Mailing Address - Country:US
Mailing Address - Phone:951-894-5072
Mailing Address - Fax:951-894-7234
Practice Address - Street 1:40700 CALIFORNIA OAKS RD STE 202
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5789
Practice Address - Country:US
Practice Address - Phone:951-894-5072
Practice Address - Fax:951-894-7234
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN243814164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse