Provider Demographics
NPI:1447892484
Name:NEELY, ROUJAE ALEXANDER
Entity type:Individual
Prefix:
First Name:ROUJAE
Middle Name:ALEXANDER
Last Name:NEELY
Suffix:
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 1:1137 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-3305
Mailing Address - Country:US
Mailing Address - Phone:323-535-9162
Mailing Address - Fax:
Practice Address - Street 1:1137 E 81ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-3305
Practice Address - Country:US
Practice Address - Phone:323-535-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider