Basic Information
| Provider Information | |||||||||
| NPI: | 1508858978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROACH | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | KEVIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14251 SILVER RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | POWAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920644969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587486303 | ||||||||
| FaxNumber: | 8587486303 | ||||||||
| Practice Location | |||||||||
| Address1: | NAVAL HOSPITAL CAMP PENDLETON | ||||||||
| Address2: | BLDG H100,SANTA MARGARITA ROAD | ||||||||
| City: | CAMP PENDLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607251620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 05/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20A7556 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.