Provider Demographics
NPI:1821187113
Name:LEVA, ROSHELLE KOLENE (LA OMD)
Entity Type:Individual
Prefix:MRS
First Name:ROSHELLE
Middle Name:KOLENE
Last Name:LEVA
Suffix:
Gender:F
Credentials:LA OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 PEACHTREE CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5873
Mailing Address - Country:US
Mailing Address - Phone:925-777-0957
Mailing Address - Fax:
Practice Address - Street 1:213 G ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1252
Practice Address - Country:US
Practice Address - Phone:925-777-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist