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NPI Code Detail

MEDICARE: ANDREA LUCIO ROSALES MA

MEDICARE:   ANDREA  LUCIO ROSALES  MA
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
1101YM0800XMental Health CounselorR6312OR
2372600000XAdult Companion

General Provider Information

NPI Number : 1578945929
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA LUCIO ROSALES MA
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number : 503-238-0769
Fax Number :
Provider Business Practice Location Address
First Line : 9620 NE TANASBOURNE DR STE 300
Second Line :
City : HILLSBORO
State : OR
Zip : 97124-7844
Country : US
Telephone Number : 503-207-5476
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2015
Last Update Date : 11/23/2022

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Directions to “ ANDREA LUCIO ROSALES MA” Practice Location

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