Provider Demographics
NPI:1639400708
Name:COLEMAN, ROSHUNDA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHUNDA
Middle Name:MICHELLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4302
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:909-882-8819
Practice Address - Street 1:190 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3658
Practice Address - Country:US
Practice Address - Phone:909-882-4788
Practice Address - Fax:909-882-8819
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA110824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01288544/DU4034OtherRAILROAD MEDICARE-SAN BERNARDINO
CAFR872ZMedicare PIN
CAP01288544/DU4034OtherRAILROAD MEDICARE-SAN BERNARDINO