Provider Demographics
NPI:1295443687
Name:ROIDE, THOMAS ERNEST II
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ERNEST
Last Name:ROIDE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29187
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-0187
Mailing Address - Country:US
Mailing Address - Phone:818-839-0759
Mailing Address - Fax:
Practice Address - Street 1:4443 AMBROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2114
Practice Address - Country:US
Practice Address - Phone:818-839-0759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty