Healthcare Provider Details

I. General information

NPI: 1316851132
Provider Name (Legal Business Name): SOLUNA ROSE HEALING AND WELLNESS, LICENSED CLINICAL SOCIAL WORKER, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 CHOLLA DR
BARSTOW CA
92311-5410
US

IV. Provider business mailing address

820 CHOLLA DR
BARSTOW CA
92311-5410
US

V. Phone/Fax

Practice location:
  • Phone: 442-229-6162
  • Fax: 442-201-0104
Mailing address:
  • Phone: 442-229-6162
  • Fax: 442-201-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROSA SCHUFF
Title or Position: PRESIDENT
Credential: LCSW
Phone: 442-229-6162