MEDICARE: MAGDELIA ROSAS RDN

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	133V00000X	Registered Dietitian		CA

General Provider Information

NPI Number	:	1962978445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGDELIA ROSAS RDN

Provider Business Mailing Address
First Line	:	28441 LAS ARUBAS
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7581
Country	:	US
Telephone Number	:	310-497-5116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 E VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-3717
Country	:	US
Telephone Number	:	323-908-4200
Fax Number	:

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

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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