Healthcare Provider Details

I. General information

NPI: 1336057736
Provider Name (Legal Business Name): LANAH BELLE ROSENWALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 PALOMAR AIRPORT RD STE 350
CARLSBAD CA
92011-1451
US

IV. Provider business mailing address

1239 ROBINSON AVE APT 207
SAN DIEGO CA
92103-4954
US

V. Phone/Fax

Practice location:
  • Phone: 760-710-2460
  • Fax: 855-864-1491
Mailing address:
  • Phone: 617-763-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRX-6E6W5F-RGQV
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: