Provider Demographics
NPI:1043700776
Name:ROSHNY PATTATHU MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ROSHNY PATTATHU MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSHNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTATHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-425-8735
Mailing Address - Street 1:17 MOMENTO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-4239
Mailing Address - Country:US
Mailing Address - Phone:949-425-8735
Mailing Address - Fax:714-464-2222
Practice Address - Street 1:999 N TUSTIN AVE STE 109
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6501
Practice Address - Country:US
Practice Address - Phone:714-775-7700
Practice Address - Fax:714-464-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center