Provider Demographics
NPI:1992847263
Name:ADJAN, ROULA SOUFI (MD)
Entity Type:Individual
Prefix:DR
First Name:ROULA
Middle Name:SOUFI
Last Name:ADJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROULA
Other - Middle Name:
Other - Last Name:AL-SOUFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10785 CALLE MAR DE MARIPOSA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8656
Mailing Address - Country:US
Mailing Address - Phone:619-865-6479
Mailing Address - Fax:
Practice Address - Street 1:7695 CARDINAL CT STE 370
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3332
Practice Address - Country:US
Practice Address - Phone:619-865-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57888OtherTHE AMERICAN BOARD OF PEDIATRICS