Healthcare Provider Details

I. General information

NPI: 1407767593
Provider Name (Legal Business Name): JAYLENE E ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 E DOUBLETREE RANCH RD STE 101
SCOTTSDALE AZ
85258-5538
US

IV. Provider business mailing address

5995 N 78TH ST UNIT 2073
SCOTTSDALE AZ
85250-6150
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-3946
  • Fax:
Mailing address:
  • Phone: 602-486-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: