Provider Demographics
NPI:1952688301
Name:ROUX, AUDREY (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:ROUX
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 1:600 SHARON PARK DR
Mailing Address - Street 2:B-306
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6948
Mailing Address - Country:US
Mailing Address - Phone:650-283-0851
Mailing Address - Fax:
Practice Address - Street 1:875 BLAKE WILBUR DR
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2205
Practice Address - Country:US
Practice Address - Phone:650-723-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist