MEDICARE: DUSTY ROSE FORTY

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1982579116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTY ROSE FORTY

Provider Business Mailing Address
First Line	:	9401 BRILLO DR
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93306-7917
Country	:	US
Telephone Number	:	661-302-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 YOUNG ST STE 400
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-8897
Country	:	US
Telephone Number	:	833-831-8946
Fax Number	:

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

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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Directions to “ DUSTY ROSE FORTY ” Practice Location

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