Provider Demographics
NPI:1962806240
Name:ROACH, PAIGE ELIZABETH
Entity type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S FLOWER ST
Mailing Address - Street 2:121
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 S FLOWER ST
Practice Address - Street 2:121
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3447
Practice Address - Country:US
Practice Address - Phone:951-707-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist