Provider Demographics
NPI:1578721551
Name:ROEN, JOSEPHINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:A
Last Name:ROEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 2ND ST APT 411
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4565
Mailing Address - Country:US
Mailing Address - Phone:415-420-5585
Mailing Address - Fax:
Practice Address - Street 1:125 2ND ST APT 411
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4565
Practice Address - Country:US
Practice Address - Phone:415-420-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics