Provider Demographics
NPI:1922180181
Name:CARROLL, ROLAND (DPM)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21250 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5506
Mailing Address - Country:US
Mailing Address - Phone:310-540-1213
Mailing Address - Fax:310-540-7405
Practice Address - Street 1:21250 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5506
Practice Address - Country:US
Practice Address - Phone:310-540-1213
Practice Address - Fax:310-540-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4492213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist