Provider Demographics
NPI:1053499384
Name:EPSTEIN, ROGER JOHN (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:JOHN
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 XIMENO AVE
Mailing Address - Street 2:#230
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2150
Mailing Address - Country:US
Mailing Address - Phone:562-494-3633
Mailing Address - Fax:
Practice Address - Street 1:1650 XIMENO AVE
Practice Address - Street 2:#230
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2150
Practice Address - Country:US
Practice Address - Phone:562-494-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG752622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0000820Medicaid
CAF42606Medicare UPIN
CAGR0000820Medicaid