Provider Demographics
NPI:1871688895
Name:ROSER, JAMES DANIEL (CPT1)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DANIEL
Last Name:ROSER
Suffix:
Gender:M
Credentials:CPT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9642 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3636
Mailing Address - Country:US
Mailing Address - Phone:714-963-2188
Mailing Address - Fax:
Practice Address - Street 1:1725 W 17TH ST STE 101-B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-834-7937
Practice Address - Fax:714-834-8235
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CACPT11532246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy