Provider Demographics
NPI:1295713386
Name:ROXAS, LUISITO M (MD)
Entity type:Individual
Prefix:DR
First Name:LUISITO
Middle Name:M
Last Name:ROXAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2045 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1088
Mailing Address - Country:US
Mailing Address - Phone:510-667-7500
Mailing Address - Fax:510-667-7522
Practice Address - Street 1:2045 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1088
Practice Address - Country:US
Practice Address - Phone:510-667-7500
Practice Address - Fax:510-667-7522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA484532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E60351Medicare UPIN