Healthcare Provider Details

I. General information

NPI: 1811525561
Provider Name (Legal Business Name): BRIANA ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/08/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 E SHEA BLVD STE 200
PHOENIX AZ
85028-3348
US

IV. Provider business mailing address

8002 E 50TH DR
DENVER CO
80238-3299
US

V. Phone/Fax

Practice location:
  • Phone: 520-485-8846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57794
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20115531
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: