Provider Demographics
NPI:1922021278
Name:ROXANNE HON MD, INC.
Entity Type:Organization
Organization Name:ROXANNE HON MD, INC.
Other - Org Name:ROXANNE HON MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:AUDREY
Authorized Official - Last Name:HON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-697-7900
Mailing Address - Street 1:8030 LA MESA BLVD
Mailing Address - Street 2:#143
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0335
Mailing Address - Country:US
Mailing Address - Phone:619-697-7900
Mailing Address - Fax:619-462-6428
Practice Address - Street 1:8030 LA MESA BLVD
Practice Address - Street 2:#143
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0335
Practice Address - Country:US
Practice Address - Phone:619-697-7900
Practice Address - Fax:619-462-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56292208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336149616OtherIND. NPI
G37811Medicare UPIN