Healthcare Provider Details

I. General information

NPI: 1003062548
Provider Name (Legal Business Name): ROSEMARY CHARMAINE DACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W. CERRITOS BUILDING 4
ANAHEIM CA
92805
US

IV. Provider business mailing address

21204 JASMINES WAY
LAKE FOREST CA
92630
US

V. Phone/Fax

Practice location:
  • Phone: 714-687-6710
  • Fax:
Mailing address:
  • Phone: 949-232-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: