Provider Demographics
NPI:1447053608
Name:ROLDAN, ANTHONY EVAN
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:EVAN
Last Name:ROLDAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 CENTER COURT DR STE 211
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3668
Mailing Address - Country:US
Mailing Address - Phone:909-371-4154
Mailing Address - Fax:
Practice Address - Street 1:5630 DUMBARTON AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3045
Practice Address - Country:US
Practice Address - Phone:909-371-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician