Provider Demographics
NPI:1497924096
Name:REPORTER, ROSHAN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:
Last Name:REPORTER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N FIGUEROA ST
Mailing Address - Street 2:ROOM 212
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2602
Mailing Address - Country:US
Mailing Address - Phone:213-240-7941
Mailing Address - Fax:213-482-4856
Practice Address - Street 1:313 N FIGUEROA ST
Practice Address - Street 2:ROOM 212
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2602
Practice Address - Country:US
Practice Address - Phone:213-240-7941
Practice Address - Fax:213-482-4856
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG613302083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine