Provider Demographics
NPI:1427253335
Name:OMANA-ROLDAN, EVELYN TAN (MD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:TAN
Last Name:OMANA-ROLDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:TAN
Other - Last Name:OMANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7331 SHELBY PL
Mailing Address - Street 2:UNIT 134
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5903
Mailing Address - Country:US
Mailing Address - Phone:484-744-4375
Mailing Address - Fax:
Practice Address - Street 1:4700 N 51ST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1237
Practice Address - Country:US
Practice Address - Phone:623-845-8200
Practice Address - Fax:623-845-8210
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine