MEDICARE: MARISSA ROSE AMAT-ROGERS MS BCBA

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	103K00000X	Behavior Analyst	1-23-69422	CA

General Provider Information

NPI Number	:	1760990600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ROSE AMAT-ROGERS MS BCBA

Provider Business Mailing Address
First Line	:	3243 SAN CARLOS DR
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1059
Country	:	US
Telephone Number	:	619-320-5235
Fax Number	:	619-599-8055

Provider Business Practice Location Address
First Line	:	3243 SAN CARLOS DR
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-1059
Country	:	US
Telephone Number	:	619-873-7067
Fax Number	:	619-639-8277

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

Provider Enumeration Date	:	01/12/2018
Last Update Date	:	11/03/2025

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