MEDICARE: JACOB CHRISTOPHER ROSALES PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95024100	CA

General Provider Information

NPI Number	:	1053018549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB CHRISTOPHER ROSALES PMHNP

Provider Business Mailing Address
First Line	:	11818 LUDWIG LN
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-2495
Country	:	US
Telephone Number	:	559-978-0619
Fax Number	:	661-381-7670

Provider Business Practice Location Address
First Line	:	8329 BRIMHALL RD STE 804
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-4386
Country	:	US
Telephone Number	:	661-431-1555
Fax Number	:	661-812-1697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	01/15/2026

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