Provider Demographics
NPI:1982816443
Name:DASALLA, ROMA CIELLA CASAS (NP)
Entity Type:Individual
Prefix:MS
First Name:ROMA CIELLA
Middle Name:CASAS
Last Name:DASALLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ROMA CIELLA
Other - Middle Name:BAILON
Other - Last Name:CASAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:B265
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-794-7333
Practice Address - Fax:310-794-7335
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555581363L00000X
CA14349363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner