Provider Demographics
NPI:1164695409
Name:ROELANDS, JENNIFER JANE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:ROELANDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 CALLE DON GUILLERMO
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7616
Mailing Address - Country:US
Mailing Address - Phone:573-355-6835
Mailing Address - Fax:
Practice Address - Street 1:301 W BASTANCHURY RD STE 140
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3427
Practice Address - Country:US
Practice Address - Phone:714-272-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC169554207VG0400X
MO2008013765207V00000X
ARC169555207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO530000002Medicare PIN